Depression is a risk factor for osteoporosis

Evidence is accumulating that depression is a risk factor for osteoporosis, reports the June 2007 issue of Harvard Women's Health Watch.

A recent study found that people ages 50 and over who regularly took antidepressants called selective serotonin reuptake inhibitors (SSRIs) had double the rate of fractures as people not using such medications. Other research points to depression itself as a source of endocrine changes that can damage bone.

Whether the danger comes from depression, the drugs used to treat it, or something else, doctors are paying more attention to this association. During the 1990s, depression began to emerge as a possible cause of bone loss, rather than a result. Scientists studied women who didn't have osteoporosis symptoms or even know they had the condition. They found lower bone mineral density in those who were depressed. Moreover, the link was found in both younger women and women past menopause. Other studies have found a similar relationship, so investigators have been looking at hormones and brain chemicals potentially involved in both depression and bone loss.

Researchers working with an animal model found that depression triggers the release of noradrenaline, which interferes with bone-building cells. Moreover, they found that imipramine—a member of an older class of drugs called tricyclic antidepressants—reversed both depression and depression-induced bone loss.

It may be a long time before the depression-osteoporosis connection is fully clarified. In the meantime, Harvard Women's Health Watch suggests that you continue taking an antidepressant if you already use one; depression is a serious illness that can have profound consequences. You may also want to talk to your doctor about getting a bone density test, and make sure you get adequate calcium.

Also in this issue:

• Update on treating IBS
• Driving safety and aging
• Simpler CPR for cardiac arrest
• By the way doctor: Tamoxifen versus aromatase inhibitors for breast cancer

Harvard Women's Health Watch is available from Harvard Health Publications, the publishing division of Harvard Medical School, for $24 per year. Subscribe at http://www.health.harvard.edu/women or by calling 1-877-649-9457 (toll free).