New research suggests that even depression may significantly increase a woman's risk for developing osteoporosis. The degree of increased bone density loss associated with depression in the study was similar to that previously associated with other well known osteoporosis risk factors, including smoking and getting little or no exercise. The average age of the women in the study was 35 and none had reached menopause.
This study corroborated earlier research suggesting a link between depression and osteoporosis. Antidepressants are NOT the answer. A study published earlier this year found that use of prescription (SSRI) antidepressants may actually worsen the bone loss.
This study, published in the Archives of Internal Medicine, included 89 women with depression between the ages of 21 and 45 and 44 similarly-aged women without depression.
Except for depression, the women in the two groups had similar risk factors for osteoporosis.
Bone mineral density testing revealed that 17% of the depressed women showed evidence of bone thinning at a particularly vulnerable area of the thigh bone, compared to 2% of women who were not depressed. Lower bone density at the lumbar spine was also seen in 20% of the depressed women, compared to 9% of women without depression.
Dr. Cizza who authored the study, says that depression was associated with a 2% reduction in bone mass at the hip—roughly seven times the expected loss for a healthy premenopausal woman and comparable to the accelerated loss seen each year in the first few years following menopause.
Other risk factors for bone loss, like low calcium intake, cigarette smoking, and lack of exercise did not explain the difference in outcomes. "Depression needs to be recognized as a risk factor for bone loss in premenopausal women and general practitioners should consider testing women with depression for osteoporosis and treating them if necessary" says the study author.
It has been suggested that specific biochemical and hormonal changes associated with depression lead to bone loss, and the study strengthens the case for the link. Study participants with depression had much higher blood levels of inflammatory proteins secreted by the immune system than the participants without depression and much lower levels of anti-inflammatory proteins.
Interestingly, fish oil is very effective for addressing both depression and inflammation.
Because early osteoporosis is primarily a silent disease, knowing that even mild depression can lead to bone loss years before fractures occur is of major clinical importance, NIMH deputy director Richard Nakamura, PhD, said in a press statement.
"Too often, the first symptom a clinician sees is when a patient shows up with a broken bone," he notes. "Now we know that depression can serve as a red flag—that depressed women are more likely than other women to approach menopause already at higher risk of fractures."
There are a number of easily modifiable factors that are likely triggering the increased rate of osteoporosis in depression. In most people with depression, an elevated cortisol is seen, and this has been considered to be a contributing factor. The elevated cortisol (relative to non-depressed controls) was not seen in this study though. What was found, however, was that the depressed group had significantly lower vitamin D levels. This can contribute to not only osteoporosis and some of the immune changes seen above, but also reflects that depressed women are not getting enough sunshine—and that this can contribute to their depression as well as to the osteoporosis.
If I am depressed, what should I do?
1. Check a DEXA scan to see if bone loss is present.
2. Read the Depression article to see how to address this naturally.
3. If bone loss is present, read the Osteoporosis article and consider taking a supplement that supports healthy bones.
4. If no osteoporosis, I would not bother with the Bone Health supplement, but either way, I would exercise (walk at least 30-60 minutes a day). This has been shown to be as or more effective than Prozac for depression—and will strengthen your bones. Do the walking outside so you get sunshine. This is a VERY healthy thing (contrary to our current ill advised medical advice to avoid sunshine). Sunshine can help both your bones and the depression. AVOID SUN BURN—NOT SUNSHINE!
5. Make sure your thyroid function is optimized (see The Cost of Missing an Underactive Thyroid).
6. For men especially (though also for women), addressing a suboptimal testosterone level with BIOIDENTICAL natural testosterone will usually help both the depression and osteoporosis—while also decreasing cholesterol and heart disease and improving diabetes!
7. Take a good multivitamin powder. Nutritional deficiencies can aggravate depression.
1. Arch Intern Med. 2007;167:2329-2336
2. Antidepressants increase bone loss. Arch Intern Med. 2007;167:1231-1232, 1240-1245
3. Elevated cortisol in depression and osteoporosis, Int J Clin Pract 61(3):416-420, 2007