title: Depression and Reduced Bone Mineral Density at the Hip and Lumbar Spine: A Comparative Meta-Analysis of Studies in Adults 60 Years and Older.
abstract: Older adults with depression are more likely to experience fractures, but it is unclear if this group has reduced bone mineral density (BMD). We conducted a systematic review and meta-analysis to compare BMD in older adults (60 years or older) with or without depression.
  
  
  
  Two independent authors conducted searches of major electronic databases from inception till April 2015. Articles that measured BMD (in g/cm) by dual-energy x-ray absorptiometry at the hip or lumbar spine in a sample with depression (including those with major depressive disorder and depressive symptoms, henceforth called "depression") and a control group were included. A random-effects meta-analysis and meta-regression were conducted.
  
  
  
  Eleven publications across 10 unique studies representing 2511 participants with depression (mean [standard deviation] = 67.4 [6.5] years, 41.8% female) and 32,574 matched controls (mean [standard deviation] = 67.5 [5.9] years, 38.9% female) were included. Only one study confirmed a diagnosis of major depressive disorder, seven studies used a screening measure to define depressive symptoms, and two studies categorized depression by antidepressant medication use. Meta-analysis established that BMD is reduced at the hip in older adults with depression (g = -0.141, 95% confidence interval = -0.220 to -0.062, p < .0001, I = 61%). Meta-analysis from seven studies suggests that lumbar spine BMD may be reduced (g = -0.122, 95% confidence interval = -0.250 to 0.005, p = .06, I = 71%).
  
  
  
  Hip BMD is reduced in older adults with depression, although the effect size is small. Nevertheless, considering the deleterious impact of hip fractures in this population, the results are important. Future research should seek to disentangle the independent effects of depression and antidepressant medication on bone loss in older age.
authors.affiliation: From the Physiotherapy Department (Stubbs), South London and Maudsley NHS Foundation Trust, and Health Service and Population Research Department (Stubbs), Institute of Psychiatry, King's College London, London, UK; AGAPLESION Bethesda Clinic, Geriatric Research Unit (Brefka, Dallmeier, Denkinger), Ulm University, Ulm, Germany; Centre of Geriatrics and Aging Research Ulm/Alb-Donau (Brefka, Dallmeier, Denkinger), Ulm, Germany; St Andrews Healthcare (Jean), Northampton, UK; UPC KU Leuven, Campus Kortenberg, Department of Neurosciences (Vancampfort), KU Leuven-University of Leuven, Kortenberg, Belgium; and Department of Rehabilitation Sciences (Vancampfort), KU Leuven-University of Leuven, Leuven, Belgium.
authors.forename: Brendon
authors.initials: B
authors.lastname: Stubbs
authors.forename: Simone
authors.initials: S
authors.lastname: Brefka
authors.forename: Dhayana
authors.initials: D
authors.lastname: Dallmeier
authors.forename: Jean
authors.initials: J
authors.lastname: Stubbs
authors.forename: Davy
authors.initials: D
authors.lastname: Vancampfort
authors.forename: Michael Dieter
authors.initials: MD
authors.lastname: Denkinger
mesh_terms: D000368:Aged; D015519:Bone Density; D003863:Depression; D003865:Major Depressive Disorder; D005260:Female; D006801:Humans; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging*; D008297:Male; D008875:Middle Aged; D010384:Pelvic Bones / Q000000981:diagnostic imaging*