title: Depressive symptoms and bone mineral density in menopause and postmenopausal women: A still increasing and neglected problem.
abstract: BACKGROUND
  The association between depression and loss of bone mineral density (BMD) has been reported as controversial.
  
  
  OBJECTIVE
  The objectıve of the current study was to investigate whether an association exists between depression and low BMD during the menopausal and postmenopausal period.
  
  
  METHODS
  A cross-sectional descriptive study was used to generate menopause symptoms experienced by Arabian women at the Primary Health Care Centers in Qatar. A multi-stage sampling design was used, and a representative sample of 1650 women aged 45-65 years were included during July 2012 and November 2013. This prospective study explored the association between bone density and major depressive disorder in women. Bone mineral densitometry measurements (BMD) (g/m(2)) were assessed at the BMD unit using a lunar prodigy DXA system (Lunar Corp., Madison, WI). Data on body mass index (BMI), clinical biochemistry variables including serum 25-hydroxyvitamin D were collected. The Beck Depression Inventory was administered for depression purposes.
  
  
  RESULTS
  Out of 1650 women 1182 women agreed to participate in the study (71.6%). The mean age and standard deviation (SD) of the menopausal age were 48.71 ± 2.96 with depressed and 50.20 ± 3.22 without depressed (P < 0.001). Furthermore, the mean and SD of postmenopausal age were 58.55 ± 3.27 with depression and 57.78 ± 3.20 without depression (P < 0.001). There were statistically significant differences between menopausal stages with regards to a number of parity, and place of living. There were statistically significant differences between menopausal stages with regards to BMI, systolic and diastolic blood pressure, Vitamin D deficiency, calcium deficiency and shisha smoking habits. Overall, osteopenia and osteoporosis and bone loss were significantly lower in postmenopausal women than in menopausal women (P < 0.001). Similarly, T-score and Z-score were lower with depression menopause and postmenopausal women (P < 0.001). The multivariate logistic regression analyses revealed that the depression, the mean serum Vitamin D deficiency, calcium level deficiency, less physical activity, comorbidity, number of parity, systolic and diastolic blood pressure and shisha smoking habits were considered as the main risk factors associated with bone mineral loss after adjusting for age, BMI and other variables.
  
  
  CONCLUSIONS
  Depression is associated with low BMD with a substantially greater BMD decrease in depressed women and cases of clinical depression. Depression should be considered as an important risk factor for osteoporosis.
authors.affiliation: Department of Biostatistics and Medical Informatics, Cerrahpaşa Faculty of Medicine, Istanbul University, Istanbul, Turkey; Department of Evidence for Population Health Unit, School of Epidemiology and Health Sciences, University of Manchester, Manchester, UK.
authors.forename: Abdulbari
authors.initials: A
authors.lastname: Bener
authors.affiliation: Department of Obstetrics and Gynecology, Women's Hospital, Hamad Medical Corporation, Doha, Qatar.
authors.forename: Najah M
authors.initials: NM
authors.lastname: Saleh
authors.affiliation: Department of Evidence for Population Health, Section of Cultural Psychiatry, Institute of Psychiatry, King's College London, Maudsley Hospital, UK.
authors.forename: Dinesh
authors.initials: D
authors.lastname: Bhugra
keywords: Bone mineral density; depression; depressive disorders; disease; menopause; physical activity; postmenopausal