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Shi H, Chen M. The brain-bone axis: unraveling the complex interplay between the central nervous system and skeletal metabolism. Eur J Med Res 2024; 29:317. [PMID: 38849920 PMCID: PMC11161955 DOI: 10.1186/s40001-024-01918-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2024] [Accepted: 06/03/2024] [Indexed: 06/09/2024] Open
Abstract
The brain-bone axis has emerged as a captivating field of research, unveiling the intricate bidirectional communication between the central nervous system (CNS) and skeletal metabolism. This comprehensive review delves into the current state of knowledge surrounding the brain-bone axis, exploring the complex mechanisms, key players, and potential clinical implications of this fascinating area of study. The review discusses the neural regulation of bone metabolism, highlighting the roles of the sympathetic nervous system, hypothalamic neuropeptides, and neurotransmitters in modulating bone remodeling. In addition, it examines the influence of bone-derived factors, such as osteocalcin and fibroblast growth factor 23, on brain function and behavior. The therapeutic potential of targeting the brain-bone axis in the context of skeletal and neurological disorders is also explored. By unraveling the complex interplay between the CNS and skeletal metabolism, this review aims to provide a comprehensive resource for researchers, clinicians, and students interested in the brain-bone axis and its implications for human health and disease.
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Affiliation(s)
- Haojun Shi
- Faculty of Chinese Medicine and State Key Laboratory of Quality Research in Chinese Medicines, Macau University of Science and Technology, Macau, Macau SAR, China
| | - Min Chen
- Faculty of Chinese Medicine and State Key Laboratory of Quality Research in Chinese Medicines, Macau University of Science and Technology, Macau, Macau SAR, China.
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Godde K, Courtney MG, Roberts J. Psychological Disorders Linked to Osteoporosis Diagnoses in a Population-Based Cohort Study of Middle and Older Age United States Adults. THE GERONTOLOGIST 2024; 64:gnae027. [PMID: 38502876 PMCID: PMC11132295 DOI: 10.1093/geront/gnae027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Indexed: 03/21/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Although it is well established that psychological disorders and osteoporosis risk are linked, how the relationship manifests is not. This study examines depressive symptoms and a history of psychological problems as potential risk factors for osteoporosis diagnosis, adjudicating between 4 theoretical models rarely tested together. We analyze these models across multiple domains (i.e., demographic, socioeconomic, and health-related), while accounting for bone mineral density (BMD) scans, which have been shown to improve health equity across sex and racial/ethnic identities. RESEARCH DESIGN AND METHODS Data from the 2012-2016, nationally representative, population-based, cohort Health and Retirement Study (N = 18,224-18,359) were used to estimate 4 logistic regression models with the outcome of osteoporosis diagnosis. Approximately 50% of the sample identified as female and 50% as male, while about 81% identified as White/European American, 11% as Black/African American, and 8% as another race/ethnicity. The key independent variables were depressive symptoms-measured using two common scales-and a history of psychological problems. RESULTS A history of psychological problems and one depressive symptoms measure were associated with the odds of osteoporosis diagnosis in the presence of other known risk factors for osteoporosis. DISCUSSION AND IMPLICATIONS Support for the theoretical models was limited. Evidence suggests possible directionality; a history of psychological distress may be a risk factor for osteoporosis, though we cannot rule out the other direction. Public health professionals and healthcare providers should consider a history of psychological problems as a risk factor for osteoporosis when deciding whether to recommend a BMD scan.
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Affiliation(s)
- K Godde
- Department of Sociology and Anthropology, University of La Verne, La Verne, California, USA
| | | | - Josephine Roberts
- Department of Sociology and Anthropology, University of La Verne, La Verne, California, USA
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Zhao P, Ying Z, Yuan C, Zhang H, Dong A, Tao J, Yi X, Yang M, Jin W, Tian W, Karasik D, Tian G, Zheng H. Shared genetic architecture highlights the bidirectional association between major depressive disorder and fracture risk. Gen Psychiatr 2024; 37:e101418. [PMID: 38737893 PMCID: PMC11086190 DOI: 10.1136/gpsych-2023-101418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 03/28/2024] [Indexed: 05/14/2024] Open
Abstract
Background There is limited evidence suggesting that osteoporosis might exacerbate depressive symptoms, while more studies demonstrate that depression negatively affects bone density and increases fracture risk. Aims To explore the relationship between major depressive disorder (MDD) and fracture risk. Methods We conducted a nested case-control analysis (32 670 patients with fracture and 397 017 individuals without fracture) and a matched cohort analysis (16 496 patients with MDD and 435 492 individuals without MDD) in the same prospective UK Biobank data set. Further, we investigated the shared genetic architecture between MDD and fracture with linkage disequilibrium score regression and the MiXeR statistical tools. We used the conditional/conjunctional false discovery rate approach to identify the specific shared loci. We calculated the weighted genetic risk score for individuals in the UK Biobank and logistic regression was used to confirm the association observed in the prospective study. Results We found that MDD was associated with a 14% increase in fracture risk (hazard ratio (HR) 1.14, 95% CI 1.14 to 1.15, p<0.001) in the nested case-control analysis, while fracture was associated with a 72% increase in MDD risk (HR 1.72, 95% CI 1.64 to 1.79, p<0.001) in the matched cohort analysis, suggesting a longitudinal and bidirectional relationship. Further, genetic summary data suggested a genetic overlap between MDD and fracture. Specifically, we identified four shared genomic loci, with the top signal (rs7554101) near SGIP1. The protein encoded by SGIP1 is involved in cannabinoid receptor type 1 signalling. We found that genetically predicted MDD was associated with a higher risk of fracture and vice versa. In addition, we found that the higher expression level of SGIP1 in the spinal cord and muscle was associated with an increased risk of fracture and MDD. Conclusions The genetic pleiotropy between MDD and fracture highlights the bidirectional association observed in the epidemiological analysis. The shared genetic components (such as SGIP1) between the diseases suggest that modulating the endocannabinoid system could be a potential therapeutic strategy for both MDD and bone loss.
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Affiliation(s)
- Pianpian Zhao
- The Affiliated Hangzhou First People’s Hospital, School of Medicine, Westlake University, Hangzhou,Zhejiang, China
- Westlake Laboratory of Life Sciences and Biomedicine, Hangzhou, Zhejiang, China
- Diseases & Population (DaP) Geninfo Lab, School of Life Sciences, Westlake University, Hangzhou, Zhejiang, China
- Institute of Basic Medical Sciences, Westlake Institute for Advanced Study, Hangzhou, Zhejiang, China
| | - Zhimin Ying
- Department of Orthopedic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Chengda Yuan
- Department of Dermatology, Hangzhou Hospital of Traditional Chinese Medicine, Hangzhou, Zhejiang, China
| | - Haisheng Zhang
- The Affiliated Hangzhou First People’s Hospital, School of Medicine, Westlake University, Hangzhou,Zhejiang, China
| | - Ao Dong
- The Affiliated Hangzhou First People’s Hospital, School of Medicine, Westlake University, Hangzhou,Zhejiang, China
- Westlake Laboratory of Life Sciences and Biomedicine, Hangzhou, Zhejiang, China
- Diseases & Population (DaP) Geninfo Lab, School of Life Sciences, Westlake University, Hangzhou, Zhejiang, China
| | - Jianguo Tao
- The Affiliated Hangzhou First People’s Hospital, School of Medicine, Westlake University, Hangzhou,Zhejiang, China
- Westlake Laboratory of Life Sciences and Biomedicine, Hangzhou, Zhejiang, China
- Diseases & Population (DaP) Geninfo Lab, School of Life Sciences, Westlake University, Hangzhou, Zhejiang, China
| | - Xiangjiao Yi
- The Affiliated Hangzhou First People’s Hospital, School of Medicine, Westlake University, Hangzhou,Zhejiang, China
- Westlake Laboratory of Life Sciences and Biomedicine, Hangzhou, Zhejiang, China
- Diseases & Population (DaP) Geninfo Lab, School of Life Sciences, Westlake University, Hangzhou, Zhejiang, China
| | - Mengyuan Yang
- The Affiliated Hangzhou First People’s Hospital, School of Medicine, Westlake University, Hangzhou,Zhejiang, China
- Westlake Laboratory of Life Sciences and Biomedicine, Hangzhou, Zhejiang, China
- Diseases & Population (DaP) Geninfo Lab, School of Life Sciences, Westlake University, Hangzhou, Zhejiang, China
| | - Wen Jin
- The Affiliated Hangzhou First People’s Hospital, School of Medicine, Westlake University, Hangzhou,Zhejiang, China
- Westlake Laboratory of Life Sciences and Biomedicine, Hangzhou, Zhejiang, China
- Diseases & Population (DaP) Geninfo Lab, School of Life Sciences, Westlake University, Hangzhou, Zhejiang, China
| | - Weiliang Tian
- Department of Global Statistics, Eli Lilly and Company, Branchburg, New Jersey, USA
| | - David Karasik
- Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
| | - Geng Tian
- Binzhou Medical University, Yantai, Shandong, China
| | - Houfeng Zheng
- The Affiliated Hangzhou First People’s Hospital, School of Medicine, Westlake University, Hangzhou,Zhejiang, China
- Westlake Laboratory of Life Sciences and Biomedicine, Hangzhou, Zhejiang, China
- Diseases & Population (DaP) Geninfo Lab, School of Life Sciences, Westlake University, Hangzhou, Zhejiang, China
- Institute of Basic Medical Sciences, Westlake Institute for Advanced Study, Hangzhou, Zhejiang, China
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Sadowsky SJ. Peri-implantitis after 40 years: Evidence, mechanisms, and implications: A mapping review. J Prosthet Dent 2023:S0022-3913(23)00114-2. [PMID: 36935269 DOI: 10.1016/j.prosdent.2023.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Revised: 02/16/2023] [Accepted: 02/16/2023] [Indexed: 03/19/2023]
Abstract
STATEMENT OF PROBLEM The high prevalence of peri-implantitis (PI) continues to plague patients and the disease is resistant to present treatment regimens. An analysis of the available research is lacking. PURPOSE Given the abundance and diversity of research on the topic of PI, the purpose of this mapping review was to synthesize the literature on the prevention of PI, the histopathology of the disease, the state of present therapeutics, and any emerging treatments. MATERIAL AND METHODS An extensive literature search was undertaken by using the electronic databases of PubMed, Web of Science, and Science Direct. The keyword strings were peri-implantitis, dental implant, risk assessment, histopathology, prosthesis design, and treatment. The filters applied were time interval from 2000 to 2002; language, English. RESULTS A total of 3635 articles were taken from PubMed, 3686 articles from Web of Science, and 2450 articles from Science Direct. After applying the inclusion and exclusion criteria to the titles and abstracts of selected investigations, 214 studies were retrieved. CONCLUSIONS The evidence reflects a concerning incidence of PI, without a predictable treatment protocol. An in-depth patient risk assessment considering risk modification, emphasis on surgical and restorative expertise, and strict recall and maintenance is essential to minimize PI.
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Affiliation(s)
- Steven J Sadowsky
- Professor, Preventive and Restorative Department, University of the Pacific Arthur A. Dugoni School of Dentistry, San Francisco, Calif.
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Efendioglu EM, Cigiloglu A, Ozturk E, Ozturk ZA. Bone mineral density response to antiosteoporotic drugs in older depressed adults. Arch Osteoporos 2023; 18:31. [PMID: 36781548 DOI: 10.1007/s11657-023-01219-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 01/26/2023] [Indexed: 02/15/2023]
Abstract
Until now, studies did not evaluate the efficacy of antiosteoporotic agents in depressed patients. We demonstrate that the presence of depression and/or serotonergic antidepressant use was associated with non-response to osteoporosis treatment in older adults. PURPOSE This study aimed to evaluate the effects of depression and antidepressants on bone mineral density (BMD) and response to antiosteoporotic agents in older adults. METHODS A total of 198 participants with osteoporosis, aged 65 and over, were included in this retrospective study. BMD was measured by dual-energy x-ray absorptiometry scanning at baseline and month 24. RESULTS Eighty-three of the 198 patients had a diagnosis of depression, and all were serotonergic antidepressant users. Baseline BMD was similar in depressed and non-depressed patients. Lumbar spine BMD change was significantly lower in depressed patients than non-depressed patients (2.89% and 4.85%, respectively, p < 0.001). In addition, of those receiving denosumab treatment, depressed ones had lower lumbar spine BMD changes. Depression and/or antidepressant use was an independent variable for non-response to osteoporosis treatment in both the femoral neck (p = 0.008, OR = 2.61) and lumbar spine (p = 0.015, OR = 6.87), while alendronate and zoledronic acid were independent variables for non-response in the femoral neck and total femur compared to denosumab. CONCLUSIONS Our study has shown that the presence of depression and/or serotonergic antidepressant use was associated with non-response to osteoporosis treatment in older adults. The results of our study may guide physicians to make treatment decisions in older individuals with depression.
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Affiliation(s)
- Eyyup Murat Efendioglu
- Faculty of Medicine, Department of Internal Medicine, Division of Geriatric Medicine, Gaziantep University, Sahinbey, 27100, Gaziantep, Turkey.
| | - Ahmet Cigiloglu
- Division of Geriatric Medicine, Kahramanmaraş Necip Fazıl City Hospital, Dulkadiroglu, 46050, Kahmaranmaraş, Turkey
| | - Ercument Ozturk
- Faculty of Medicine, Department of Internal Medicine, Division of Geriatric Medicine, Gaziantep University, Sahinbey, 27100, Gaziantep, Turkey
| | - Zeynel Abidin Ozturk
- Faculty of Medicine, Department of Internal Medicine, Division of Geriatric Medicine, Gaziantep University, Sahinbey, 27100, Gaziantep, Turkey
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Early Life Stress (ELS) Effects on Fetal and Adult Bone Development. CHILDREN (BASEL, SWITZERLAND) 2023; 10:children10010102. [PMID: 36670652 PMCID: PMC9856960 DOI: 10.3390/children10010102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 12/21/2022] [Accepted: 12/30/2022] [Indexed: 01/05/2023]
Abstract
Early life stress (ELS) refers to harmful environmental events (i.e., poor maternal health, metabolic restraint, childhood trauma) occurring during the prenatal and/or postnatal period, which may cause the 'epigenetic corruption' of cellular and molecular signaling of mental and physical development. While the impact of ELS in a wide range of human diseases has been confirmed, the ELS susceptibility to bone diseases has been poorly explored. In this review, to understand the potential mediating pathways of ELS in bone diseases, PRISMA criteria were used to analyze different stress protocols in mammal models and the effects elicited in dams and their progeny. Data collected, despite the methodological heterogeneity, show that ELS interferes with fetal bone formation, also revealing that the stress type and affected developmental phase may influence the variety and severity of bone anomalies. Interestingly, these findings highlight the maternal and fetal ability to buffer stress, establishing a new role for the placenta in minimizing ELS perturbations. The functional link between ELS and bone impairments will boost future investigations on maternal stress transmission to the fetus and, parallelly, help the assessment of catch-up mechanisms of skeleton adaptations from the cascading ELS effects.
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Lohman MC, Mezuk B, Fairchild AJ, Resciniti NV, Merchant AT. The role of frailty in the association between depression and fall risk among older adults. Aging Ment Health 2022; 26:1805-1812. [PMID: 35993919 PMCID: PMC9395731 DOI: 10.1080/13607863.2021.1950616] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVES Although there is a recognized association between depression and greater fall risk among older adults, the mechanisms explaining this association are unclear. This study evaluated the role of frailty, a common geriatric syndrome, in determining greater risk of falls among older adults with depression. METHOD We used longitudinal data from three biennial waves of the Health and Retirement Study (HRS; 2010-2014). The sample included community-dwelling survey respondents age ≥ 65 who participated in objective physiological measures. Major Depression (MD) was measured using Composite International Diagnostic Interview for depression short form. Frailty was measured using criteria outlined in the frailty phenotype model. Causal mediation analysis was used to differentiate the direct effect of depression and indirect effect mediated by frailty on falls, fall injuries, and multiple falls. RESULTS Major depression was associated with significantly greater odds of experiencing a fall (OR: 1.91; 95% CI: 1.31, 2.77), fall injury (OR: 1.86; 95% CI: 1.17, 2.95), and multiple falls (OR: 2.26; 95% CI: 1.52, 3.37) over a two-year period. Frailty was a significant mediator of the effects of depression on falls and multiple falls, accounting for approximately 18.9% and 21.3% of the total effects, respectively. We found no evidence of depression-frailty interaction. Sensitivity analyses showed that results were robust to unmeasured confounding and alternative operationalizations of depression. CONCLUSION Frailty explains a significant proportion of increased likelihood of falls among older adults with depression. Treatment and management of frailty symptoms may be an important components of fall prevention among older adults with depression.
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Affiliation(s)
- Matthew C. Lohman
- Department of Epidemiology and Biostatistics, University of South Carolina, Arnold School of Public Health, Columbia, SC
| | - Briana Mezuk
- Center for Social Epidemiology and Population Health, Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI
| | | | - Nicholas V. Resciniti
- Department of Epidemiology and Biostatistics, University of South Carolina, Arnold School of Public Health, Columbia, SC
| | - Anwar T. Merchant
- Department of Epidemiology and Biostatistics, University of South Carolina, Arnold School of Public Health, Columbia, SC
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Xiong J, Liao J, Liu X, Zhang Z, Adams J, Pacifici R, Ye K. A TrkB agonist prodrug prevents bone loss via inhibiting asparagine endopeptidase and increasing osteoprotegerin. Nat Commun 2022; 13:4820. [PMID: 35973996 PMCID: PMC9381595 DOI: 10.1038/s41467-022-32435-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Accepted: 07/26/2022] [Indexed: 11/12/2022] Open
Abstract
Brain-derived neurotrophic factor (BDNF) and its tropomyosin-related kinase B receptor (TrkB) are expressed in human osteoblasts and mediate fracture healing. BDNF/TrkB signaling activates Akt that phosphorylates and inhibits asparagine endopeptidase (AEP), which regulates the differentiation fate of human bone marrow stromal cells (hBMSC) and is altered in postmenopausal osteoporosis. Here we show that R13, a small molecular TrkB receptor agonist prodrug, inhibits AEP and promotes bone formation. Though both receptor activator of nuclear factor kappa-Β ligand (RANK-L) and osteoprotegerin (OPG) induced by ovariectomy (OVX) remain comparable between WT and BDNF+/− mice, R13 treatment significantly elevates OPG in both mice without altering RANKL, blocking trabecular bone loss. Strikingly, both R13 and anti-RANK-L exhibit equivalent therapeutic efficacy. Moreover, OVX increases RANK-L and OPG in WT and AEP KO mice with RANK-L/OPG ratio lower in the latter than the former, attenuating bone turnover. 7,8-DHF, released from R13, activates TrkB and its downstream effector CREB, which is critical for OPG augmentation. Consequently, 7,8-DHF represses C/EBPβ/AEP pathway, inhibiting RANK-L-induced RAW264.7 osteoclastogenesis. Therefore, our findings support that R13 exerts its therapeutic efficacy toward osteoporosis via inhibiting AEP and escalating OPG. BDNS and TrkB are involved in bone fracture healing by inhibiting AEP. Here the authors show that a TrkB agonist prodrug can inhibit AEP and promote bone formation in osteoporotic mice.
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Affiliation(s)
- Jing Xiong
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, GA, 30322, USA.,Department of Neurology, Renmin Hospital of Wuhan University, Wuhan, 430060, Hubei Province, PR China
| | - Jianming Liao
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, GA, 30322, USA.,Department of Neurosurgery, Renmin Hospital of Wuhan University, Wuhan, 430060, Hubei Province, PR China
| | - Xia Liu
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, GA, 30322, USA
| | - Zhaohui Zhang
- Department of Neurology, Renmin Hospital of Wuhan University, Wuhan, 430060, Hubei Province, PR China
| | - Jonathan Adams
- Division of Endocrinology, Metabolism and Lipids, Department of Medicine, Emory University School of Medicine, Atlanta, GA, 30322, USA
| | - Roberto Pacifici
- Division of Endocrinology, Metabolism and Lipids, Department of Medicine, Emory University School of Medicine, Atlanta, GA, 30322, USA
| | - Keqiang Ye
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, GA, 30322, USA. .,Faculty of Life and Health Sciences, Shenzhen Institute of Advanced Technology (SIAT) Shenzhen, Guangdong, PR China.
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Shin MK, Kim H, Choi SH, Kim BJ, Kwon O. Sex-specific bi‑directional association between osteoporosis and depression from the national representative data of South Korea. Sci Rep 2022; 12:9500. [PMID: 35680922 PMCID: PMC9184731 DOI: 10.1038/s41598-022-13401-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Accepted: 05/24/2022] [Indexed: 11/16/2022] Open
Abstract
Both osteoporosis and depression are major health threats, but their interrelationship is not clear. This study elucidated the associations between osteoporosis and depression while considering the temporal sequence of the diagnoses. In this cross-sectional study, data were extracted from the Korean National Health and Nutrition Examination Surveys (2007-2009 and 2015-2019, n = 29,045). Osteoporosis and depression were defined by diagnoses thereof. The odds ratio (OR) of the incident osteoporosis among depression patients without a history of osteoporosis was calculated by multivariable logistic regression adjusted for potential confounders. A reverse association was also assessed. Participants were additionally stratified by their sex and age. As a result, male depression patients aged under 50 years showed higher ORs for osteoporosis than those without depression (OR 9.16, 95% CI 1.78-47.18). Female osteoporosis patients showed lower ORs for depression than those without osteoporosis (OR 0.71, 95% CI 0.58-0.88), especially in women aged 50 years and older. In the sensitivity analysis, the same results were obtained in women by their menopause status. Depression has a strong positive association with the occurrence of osteoporosis in young male adults, and osteoporosis has a negative association with the occurrence of depression in female adults.
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Affiliation(s)
- Min Kyoung Shin
- Department of Biomedical Sciences, Seoul National University College of Medicine, Seoul, 03080, Korea
- Department of Biochemistry and Molecular Biology, Seoul National University College of Medicine, Seoul, 03080, Korea
| | - Hyejin Kim
- Department of Public Health, Yonsei University Graduate School, Seoul, 03722, Korea
| | - Soo-Hee Choi
- Department of Psychiatry, Seoul National University College of Medicine, Seoul, 03080, Korea
- Department of Psychiatry, Seoul National University Hospital, Seoul, 03080, Korea
| | - Beom-Jun Kim
- Department of Endocrinology and Metabolism, Asan Medical Center, University of Ulsan College of Medicine, Seoul, 05505, Korea
| | - Obin Kwon
- Department of Biomedical Sciences, Seoul National University College of Medicine, Seoul, 03080, Korea.
- Department of Biochemistry and Molecular Biology, Seoul National University College of Medicine, Seoul, 03080, Korea.
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Ng JS, Chin KY. Potential mechanisms linking psychological stress to bone health. Int J Med Sci 2021; 18:604-614. [PMID: 33437195 PMCID: PMC7797546 DOI: 10.7150/ijms.50680] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 11/30/2020] [Indexed: 02/06/2023] Open
Abstract
Chronic psychological stress affects many body systems, including the skeleton, through various mechanisms. This review aims to provide an overview of the factors mediating the relationship between psychological stress and bone health. These factors can be divided into physiological and behavioural changes induced by psychological stress. The physiological factors involve endocrinological changes, such as increased glucocorticoids, prolactin, leptin and parathyroid hormone levels and reduced gonadal hormones. Low-grade inflammation and hyperactivation of the sympathetic nervous system during psychological stress are also physiological changes detrimental to bone health. The behavioural changes during mental stress, such as altered dietary pattern, cigarette smoking, alcoholism and physical inactivity, also threaten the skeletal system. Psychological stress may be partly responsible for epigenetic regulation of skeletal development. It may also mediate the relationship between socioeconomic status and bone health. However, more direct evidence is required to prove these hypotheses. In conclusion, chronic psychological stress should be recognised as a risk factor of osteoporosis and stress-coping methods should be incorporated as part of the comprehensive osteoporosis-preventing strategy.
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Affiliation(s)
- Jia-Sheng Ng
- Department of Pharmacology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Cheras 56000, Malaysia
| | - Kok-Yong Chin
- Department of Pharmacology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Cheras 56000, Malaysia
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Effects of Early Life Stress on Bone Homeostasis in Mice and Humans. Int J Mol Sci 2020; 21:ijms21186634. [PMID: 32927845 PMCID: PMC7556040 DOI: 10.3390/ijms21186634] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2020] [Revised: 08/27/2020] [Accepted: 09/05/2020] [Indexed: 11/16/2022] Open
Abstract
Bone pathology is frequent in stressed individuals. A comprehensive examination of mechanisms linking life stress, depression and disturbed bone homeostasis is missing. In this translational study, mice exposed to early life stress (MSUS) were examined for bone microarchitecture (μCT), metabolism (qPCR/ELISA), and neuronal stress mediator expression (qPCR) and compared with a sample of depressive patients with or without early life stress by analyzing bone mineral density (BMD) (DXA) and metabolic changes in serum (osteocalcin, PINP, CTX-I). MSUS mice showed a significant decrease in NGF, NPYR1, VIPR1 and TACR1 expression, higher innervation density in bone, and increased serum levels of CTX-I, suggesting a milieu in favor of catabolic bone turnover. MSUS mice had a significantly lower body weight compared to control mice, and this caused minor effects on bone microarchitecture. Depressive patients with experiences of childhood neglect also showed a catabolic pattern. A significant reduction in BMD was observed in depressive patients with childhood abuse and stressful life events during childhood. Therefore, future studies on prevention and treatment strategies for both mental and bone disease should consider early life stress as a risk factor for bone pathologies.
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Yu X, Zhang Y, Han P, Fu L, Chen X, Hou L, Song P, Zhao Y, Guo Q. Effects of different living conditions on the risk of osteoporosis in Chinese community-dwelling elderly: a 3-year cohort study. J Int Med Res 2020; 48:300060520943450. [PMID: 32777962 PMCID: PMC7425277 DOI: 10.1177/0300060520943450] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
Objective Osteoporosis can lead to bone fragility and an increased risk of bone fracture with resultant high morbidity and mortality. Living alone has been associated with various mental and physical health problems. However, the risk of osteoporosis among individuals with different living conditions and changing living conditions is unclear. We examined the risk of osteoporosis in different living conditions over a 3-year period in community-dwelling suburban elderly Chinese. Methods This study involved 288 elderly Chinese suburb-dwelling participants with no documented history of osteoporosis. All were aged ≥60 years (mean, 65.6±3.75 years; 157 men). A quantitative ultrasound scan of the calcaneus with a T score of <−2.5 was used to identify a high risk of osteoporosis. Results In total, 54.2% of participants were determined to have a high risk of osteoporosis (male, 51.6%; female, 57.3%). People who had always lived alone had a significantly higher risk of osteoporosis, even after adjusting for potential confounders. A change from living alone to living with others had no significant impact on the risk of osteoporosis. Conclusion Our results indicate that living alone is associated with a high risk of osteoporosis. Thus, people who live alone may need regular bone tests to avoid adverse events.
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Affiliation(s)
- Xing Yu
- Department of Rehabilitation Medicine, Shanghai University of Medicine and Health Sciences Affiliated Zhoupu Hospital, Shanghai, China
| | - Yuanyuan Zhang
- Department of Rehabilitation Medicine, Tianjin Medical University, Tianjin, China
| | - Peipei Han
- Department of Rehabilitation Medicine, Shanghai University of Medicine and Health Sciences, Shanghai, China
| | - Liyuan Fu
- Department of Rehabilitation Medicine, Tianjin Medical University, Tianjin, China
| | - Xiaoyu Chen
- Department of Rehabilitation Medicine, Tianjin Medical University, Tianjin, China
| | - Lin Hou
- Department of Rehabilitation Medicine, Tianjin Medical University, Tianjin, China
| | - Peiyu Song
- Department of Rehabilitation Medicine, Tianjin Medical University, Tianjin, China
| | - Yong Zhao
- Department of Rehabilitation Medicine, Shanghai University of Medicine and Health Sciences, Shanghai, China
| | - Qi Guo
- Department of Rehabilitation Medicine, Shanghai University of Medicine and Health Sciences Affiliated Zhoupu Hospital, Shanghai, China
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13
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Crosstalk of Brain and Bone-Clinical Observations and Their Molecular Bases. Int J Mol Sci 2020; 21:ijms21144946. [PMID: 32668736 PMCID: PMC7404044 DOI: 10.3390/ijms21144946] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 07/06/2020] [Accepted: 07/06/2020] [Indexed: 02/06/2023] Open
Abstract
As brain and bone disorders represent major health issues worldwide, substantial clinical investigations demonstrated a bidirectional crosstalk on several levels, mechanistically linking both apparently unrelated organs. While multiple stress, mood and neurodegenerative brain disorders are associated with osteoporosis, rare genetic skeletal diseases display impaired brain development and function. Along with brain and bone pathologies, particularly trauma events highlight the strong interaction of both organs. This review summarizes clinical and experimental observations reported for the crosstalk of brain and bone, followed by a detailed overview of their molecular bases. While brain-derived molecules affecting bone include central regulators, transmitters of the sympathetic, parasympathetic and sensory nervous system, bone-derived mediators altering brain function are released from bone cells and the bone marrow. Although the main pathways of the brain-bone crosstalk remain ‘efferent’, signaling from brain to bone, this review emphasizes the emergence of bone as a crucial ‘afferent’ regulator of cerebral development, function and pathophysiology. Therefore, unraveling the physiological and pathological bases of brain-bone interactions revealed promising pharmacologic targets and novel treatment strategies promoting concurrent brain and bone recovery.
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Kim SK, Hong SM, Park IS, Lee HJ, Park B, Choi HG. Mood Disorders are Associated With Increased Risk of BPPV: A National Sample Cohort. Laryngoscope 2020; 131:380-385. [PMID: 32198944 DOI: 10.1002/lary.28638] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 02/26/2020] [Accepted: 02/27/2020] [Indexed: 01/10/2023]
Abstract
OBJECTIVES Few studies have reported that mood disorders increase the risk of benign paroxysmal positional vertigo (BPPV). The purpose of our study was to demonstrate whether the incidence of BPPV in those with mood disorders differs from that in a matched control group. STUDY DESIGN Nationwide cohort observational study. METHODS Korean Health Insurance Review and Assessment Service-National Patient Samples were collected from 2002 to 2013. A 1:4 matched mood disorder group (n = 59,340) and control group (n = 237,720) were selected. The crude and adjusted (cerebral stroke, ischemic heart disease, anxiety disorder, and osteoporosis histories) hazard ratios (HRs) for depression and BPPV were analyzed using a stratified Cox proportional hazard model. The results were stratified by age, sex, income, region of residence, hypertension, diabetes, and dyslipidemia in these analyses. RESULTS The incidence of BPPV was significantly higher in the mood disorder group than in the control group (3.2% vs. 2.1%, P < .001). Mood disorder increased the risk of BPPV (adjusted HR = 1.31, 95% confidence interval [CI] = 1.23-1.39, P < .001). In subgroup analyses, the incidence of BPPV in all age groups and in both sexes was significantly higher in the mood disorder group than in the control group. CONCLUSION This population-based cohort study demonstrates that mood disorder was significantly associated with BPPV. LEVEL OF EVIDENCE N/A. Laryngoscope, 131:380-385, 2021.
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Affiliation(s)
- Sung Kyun Kim
- Department of Otorhinolaryngology-Head & Neck Surgery, Hallym University College of Medicine, Hwaseong, South Korea
| | - Seok Min Hong
- Department of Otorhinolaryngology-Head & Neck Surgery, Hallym University College of Medicine, Hwaseong, South Korea
| | - Il-Seok Park
- Department of Otorhinolaryngology-Head & Neck Surgery, Hallym University College of Medicine, Hwaseong, South Korea
| | - Hyo-Jung Lee
- Department of Otorhinolaryngology-Head & Neck Surgery, Hallym University College of Medicine, Anyang, South Korea
| | - Bumjung Park
- Department of Otorhinolaryngology-Head & Neck Surgery, Hallym University College of Medicine, Anyang, South Korea
| | - Hyo Geun Choi
- Department of Otorhinolaryngology-Head & Neck Surgery, Hallym University College of Medicine, Anyang, South Korea.,Hallym Data Science Laboratory, Hallym University College of Medicine, Anyang, South Korea
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15
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Kouvatsou K, Iliadou M, Kalatzi P, Evanthia S, Christos P, Maria K, Tziaferi S. Depression Among Elderly Users of Open and Closed Care Facilities in a Rural Region of Greece: an Important Public Health Issue. Mater Sociomed 2020; 32:35-40. [PMID: 32410889 PMCID: PMC7219719 DOI: 10.5455/msm.2020.32.35-40] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Introduction: It is estimated that 5.7% of the total Greek population suffers from depressive disorders. Elderly may be particularly prone to depression compared to younger people. In Greece, there is a paucity of literature regarding the correlation between the existence of chronic diseases, sociodemographic features, participation in open/ closed structures, and the presence of depression or depressive symptoms, among seniors. The purpose of this study was to explore potential correlations between the above- mentioned variables, as a whole. Methods: This was a cross- sectional, questionnaire survey of 200 elderly aged 65 or above and were members of 12 Open Care Centers for the Elderly (OCCE) or residents in 2 nursing homes located in the rural region of Epirus, in Greece. Data collection took place in the form of structured individual interviews. For the identification of independent factors associated with the existence of depressive symptoms, stepwise logistic regression analysis was performed. Results: A total of 81 (40.5%) seniors experienced depressive symptoms, though only 39 of them (19.5%) had been diagnosed for depression. Depression rates were higher for those with more chronic diseases (p=0.01) and at divorced, widowed and single seniors compared to married ones (50.5% vs. 28.1% respectively, p=0.002). The prevalence of depression was higher among the elderly who lived in nursing homes compared to the participants who were registered members of the OCCE (50% vs. 35.6% respectively, p=0.049), while elderly who often participated in the social activities of OCCE, had significantly lower rates of depressive symptoms compared to those who scarcely were involved in these activities (23% vs. 46.2% respectively, p=0.019). Participants who suffered from osteoporosis were more likely of displaying depressive symptoms compared to those who didn’t; OR (95% Confidence Interval) = 2.61 (1.28-5.33), p=0.009. Conclusions: The existence of an action plan that includes education and training of health professionals on mental health of the elderly and the satisfactory operation of public facilities to promote the wellbeing of seniors and offer more incentives for activity participation, may reduce depression rates and the under-diagnosis of the disease.
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Affiliation(s)
- Katerina Kouvatsou
- Department of Nursing, Faculty of Human Movement and Quality of Life Sciences, University of Peloponnese, Tripoli, Greece
| | - Maria Iliadou
- Department of Nursing, Faculty of Human Movement and Quality of Life Sciences, University of Peloponnese, Tripoli, Greece.,Department of Midwifery, Faculty of Health and Care Sciences, University of West Attica, Aigaleo, Athens, Greece
| | - Panagiota Kalatzi
- Department of Nursing, Faculty of Human Movement and Quality of Life Sciences, University of Peloponnese, Tripoli, Greece
| | - Sakellari Evanthia
- Department of Public and Community Health, Faculty of Public Health University of West Attica, Athens, Greece
| | - Prapas Christos
- Department of Public and Community Health, Faculty of Public Health University of West Attica, Athens, Greece
| | - Kalafati Maria
- Faculty of Nursing, National and Kapodistrian University of Athens, Athens, Greece
| | - Styliani Tziaferi
- Department of Nursing, Faculty of Human Movement and Quality of Life Sciences, University of Peloponnese, Tripoli, Greece
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16
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Beneficial effects of anti-RANKL antibody in depression-like phenotype, inflammatory bone markers, and bone mineral density in male susceptible mice after chronic social defeat stress. Behav Brain Res 2019; 379:112397. [PMID: 31790783 DOI: 10.1016/j.bbr.2019.112397] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Revised: 11/27/2019] [Accepted: 11/28/2019] [Indexed: 12/19/2022]
Abstract
Multiple lines of evidence suggest a link between depression and osteoporosis in elderly people. Receptor activator of nuclear factor-κB ligand (RANKL) plays a role in the pathology of osteoporosis, and anti-RANKL antibody has been used in the treatment of osteoporosis. In this study, we investigated whether anti-mouse RANKL antibody could attenuate depression-like phenotypes, inflammatory bone markers and bone mineral density (BMD) in male susceptible mice after chronic social defeat stress (CSDS). We measured plasma levels of inflammatory bone markers, including osteoprotegerin (OPG), RANKL, and osteopontin. A single intravenous injection of anti-RANKL (2 mg/kg) elicited rapid antidepressant effects in CSDS susceptible mice. Furthermore, anti-RANKL significantly improved the increased plasma levels of RANKL and decreased OPG/RANKL ratio in CSDS susceptible mice. Moreover, anti-RANKL significantly attenuated the decreased BMD in CSDS susceptible mice. Interestingly, there is a positive correlation between anhedonia-like behavior and OPG/RANKL ratio in mice. These findings demonstrate that anti-RANKL may have beneficial effects in depression-like phenotype and abnormalities in bone functions of CSDS susceptible mice. It is, therefore, likely that anti-human RANKL antibody (i.e., Denosumab) would be a potential therapeutic drug for depression and osteoporosis.
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17
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Amphansap T, Sujarekul P. Quality of life and factors that affect osteoporotic hip fracture patients in Thailand. Osteoporos Sarcopenia 2019; 4:140-144. [PMID: 30775557 PMCID: PMC6372845 DOI: 10.1016/j.afos.2018.11.082] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Revised: 11/06/2018] [Accepted: 11/17/2018] [Indexed: 11/30/2022] Open
Abstract
Objectives The aim of this study was to report the health-related quality of life (HRQoL) over the first year after osteoporotic hip fracture and to identify the factors associated with HRQoL in Police General Hospital in Thailand. Methods A prospective cohort study was conducted. 139 subjects who had osteoporotic hip fracture were recruited, which they will be assessed during the preinjury recall and at 3, 6, and 12 months after the fracture. HRQoL was measured as Thailand health state utility values (THSUVs), which derived from EuroQol-5-Dimension-3-Level. Factors associated with the change in QoL were analyzed. Results One hundred thirty-six patients with a hip fracture were included for analysis. Their mean age was 82 ± 11 years old. The mean ± standard deviation (SD) of QoL score and EQ VAS at 12-month follow-up period were lower than before the fracture ([0.68 ± 0.105 vs. 0.55 ± 0.183] and [85 ± 10.5 vs. 79 ± 19.2]). The mean ± SD of QoL score and EQ VAS, compared before and after the fracture was estimated at −0.13 ± 0.164 and −6 ± 14.7 (P = 0.01). The positive influences on the change in QoL score were present in the subject, who are younger than 80 years old, had normal or high body mass index (BMI), and had operative treatment. Conclusions Osteoporotic hip fractures incurred substantial loss in HRQoL which was markedly impaired at first 3 months after hip fracture and after that HRQoL was improved but did not return to prefracture levels. So primary prevention of fall is more important. The changes in HRQoL, was influenced by age, BMI, and operative treatment.
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Affiliation(s)
- Tanawat Amphansap
- Orthopaedic Department, Police General Hospital, 492/1 Rama1 Road, Prathumwan, Bangkok, Thailand
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18
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Should clinicians pay more attention to the potential underdiagnosis of osteoporosis in patients with ankylosing spondylitis? A national population-based study in Taiwan. PLoS One 2019; 14:e0211835. [PMID: 30726282 PMCID: PMC6364934 DOI: 10.1371/journal.pone.0211835] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Accepted: 01/21/2019] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVES There are limited studies describing the association between ankylosing spondylitis (AS) and osteoporosis. We conducted a nationwide retrospective cohort study to investigate this epidemiologic evidence. METHODS Data were obtained from the Taiwan National Health Insurance Research Database (NHIRD). Of 10,290 participants, 2,058 patients with AS and 8,232 patients without AS were enrolled from the NHIRD between 2000 to 2013. Cumulative incidences of osteoporosis were compared between 2 groups. Cox regression model was used to estimate the hazard ratio (HR) of developing osteoporosis after controlling for demographic and other co-morbidities, and subgroup analyses were conducted to examine the risk factors for osteoporosis in AS patients. RESULTS The incidence rate ratio (IRR) of osteoporosis in AS patients was 2.17 times higher than that non-AS group (95% confidence interval [CI], 1.83-2.57). The adjusted HRs of osteoporosis for AS patients after controlling for demographic characteristics and comorbid medical disorders was 1.99 (95% CI 1.68-2.36). Among AS group, after adjustment for major comorbidities, old age (≥65 years, HR 4.32, 95% CI 3.01-6.18), female sex (HR 2.48, 95% CI 1.87-3.28), dyslipidemia (HR 1.44, 95% CI 1.01-2.06) were risk factors associated with osteoporosis. CONCLUSIONS This cohort study demonstrated that patients with AS had a higher risk of developing osteoporosis, especially in those aged over 65, female sex and with dyslipidemia in this patient group.
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19
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DeShields SC, Cunningham TD. Comparison of osteoporosis in US adults with type 1 and type 2 diabetes mellitus. J Endocrinol Invest 2018; 41:1051-1060. [PMID: 29353395 DOI: 10.1007/s40618-018-0828-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2017] [Accepted: 01/07/2018] [Indexed: 12/11/2022]
Abstract
PURPOSE We examined bone mineral density (BMD) and osteoporosis prevalence in those with type 1 compared to type 2 diabetes derived from a nationally representative sample from the civilian community in the United States. METHODS Data from the National Health and Nutrition Examination Survey (NHANES) for 2005-2006, 2007-2008, 2009-2010, and 2013-2014 were merged to obtain a large sample of diabetics at least 20 years of age with participation in the interview and medical examination. Osteoporosis status was defined by BMD at the total femur, femoral neck, or total lumbar spine. Self-reported diabetics that were prescribed insulin within the first year of diagnosis, are currently taking insulin, and reported no prescriptions for any diabetic pills were classified as type 1. Remaining self-reported diabetics were deemed as having type 2. RESULTS A total of 2050 diabetics were included in which 87 (4%) were classified as type 1. Type 1 diabetics were found to have a significantly lower BMD at the total femur and femoral neck, but not at the lumbar spine in the adjusted models. Diabetics with type 1 were 4.7 times more likely to have osteoporosis than those with type 2. There was no significant relationship between diabetes type and BMD or osteoporosis prior to adjustment for confounders. CONCLUSIONS Although our results show an increased likelihood of osteoporosis among those with type 1 diabetes, future studies including a larger sample from a community population are needed. It may benefit diabetics, especially those with type 1, to initiate osteoporosis screening methods including evaluation of fracture risk, bone quality, and BMD measurements at multiple sites earlier than recommended.
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Affiliation(s)
- S C DeShields
- The Center for Health Analytics and Discovery, Eastern Virginia Medical School, Harry Lester Building, 651 Colley Avenue, Room 402, Norfolk, VA, 23507, USA.
| | - T D Cunningham
- The Center for Health Analytics and Discovery, Eastern Virginia Medical School, Harry Lester Building, 651 Colley Avenue, Room 402, Norfolk, VA, 23507, USA
- Master of Healthcare Delivery Science Program, Eastern Virginia Medical School, Norfolk, VA, 23501, USA
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20
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Schweiger JU, Schweiger U, Hüppe M, Kahl KG, Greggersen W, Jauch-Chara K, Fassbinder E. The Use of Antidepressive Agents and Bone Mineral Density in Women: A Meta-Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15071373. [PMID: 29966324 PMCID: PMC6069102 DOI: 10.3390/ijerph15071373] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Revised: 06/26/2018] [Accepted: 06/28/2018] [Indexed: 11/23/2022]
Abstract
Antidepressive agents are one of the fastest-growing classes of prescribed drugs. However, the effects of antidepressive agents on bone density are controversial. The aim of this meta-analysis is to evaluate the state of research on the relationship between the use of tricyclic antidepressants (TCAs) or selective serotonin reuptake inhibitors (SSRIs) and bone mineral density (BMD) in women. The database searched was Pubmed. The meta-analysis included human studies in women fulfilling the following criteria: (i) an assessment of bone mineral density in the lumbar spine, the femoral neck or the total hip; (ii) a comparison of the BMD of depressed individuals using antidepressive agents (SSRIs or TCAs), and a control group that did not use antidepressive agents; (iii) measurement of BMD using dual-energy X-ray absorptiometry (DXA); and (iv) calculations of the mean BMD and standard deviation or standard error. Four studies were identified, which, in total, included 934 women using antidepressive agents and 5767 non-using individuals. The results showed that no significant negative composite weighted mean effect sizes were identified for the comparisons between SSRI users and non-users. Similarly, no significant negative composite weighted mean effect sizes were identified for the comparisons between TCA users and non-users, indicating similar BMD in SSRI or TCA users and non-users. The meta-analysis shows that the association between antidepressant medication and bone mineral density has not been extensively researched. Only four studies fulfilled the inclusion criteria. The global result of the literature review and meta-analysis was that the use of antidepressive agents was not associated with lower or higher BMD. This result applies to both SSRIs and TCAs and to all measurement locations (lumbar spine, femoral neck and total hip).
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Affiliation(s)
| | - Ulrich Schweiger
- Department of Psychiatry and Psychotherapy, Medical School, Lübeck University, Ratzeburger Allee 160, D-23538 Lübeck, Germany.
| | - Michael Hüppe
- Department of Anesthesiology, Medical School, Lübeck University, Ratzeburger Allee 160, 23538 Lübeck, Germany.
| | - Kai G Kahl
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Carl-Neuberg-Straße 1, 30625 Hannover, Germany.
| | - Wiebke Greggersen
- Department of Psychiatry and Psychotherapy, Medical School, Lübeck University, Ratzeburger Allee 160, D-23538 Lübeck, Germany.
| | - Kamila Jauch-Chara
- Department of Psychiatry and Psychotherapy, Medical School, Lübeck University, Ratzeburger Allee 160, D-23538 Lübeck, Germany.
| | - Eva Fassbinder
- Department of Psychiatry and Psychotherapy, Medical School, Lübeck University, Ratzeburger Allee 160, D-23538 Lübeck, Germany.
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Abstract
Aims A high rate of suicide has been reported in patients who sustain fractures, but the association remains uncertain in the context of other factors. The aim of this study was to examine the association between fractures and the risk of suicide in this contextual setting. Patients and Methods We performed a case-control study of patients aged 40 years or older who died by suicide between 2000 and 2011. We included patients’ demographics, physical and mental health problems, and socioeconomic factors. We performed conditional logistic regression to evaluate the associations between fractures and the risk of suicide. Results We included a total of 34 794 patients who died by suicide and 139 176 control patients. We found that fractures as a homogenous group (adjusted odds ratios (aOR), 1.48; 95% confidence interval (CI) 1.43 to 1.53), and specifically pelvic (aOR 2.04; 95% CI 1.68 to 2.47) and spinal fractures (aOR 1.53; 95% CI 1.43 to 1.64), were associated with a higher risk of suicide. In addition, we found that patients who had a lower income, had never married, had lower levels of educational attainment, or had coexistent physical and mental conditions such as anxiety, mood disorders, and psychosis-related disorders had a higher risk of suicide. Conclusion Fractures, specifically those of the hip and spine, were associated with an increased risk of suicide. The findings suggest that greater clinical attention should be given to this risk in patients with fractures, especially for those with additional risk factors. Cite this article: Bone Joint J 2018;100-B:780–6.
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Affiliation(s)
- C-F. Chang
- General Institute of Medical Science,
National Defense Medical Center and Department of Radiology,
Tri-Service General Hospital, Taipei, Taiwan
| | - E. C-C. Lai
- School of Pharmacy,
Institute of Clinical Pharmacy and Pharmaceutical Sciences, National
Cheng Kung University, Tainan, Taiwan
| | - M-K. Yeh
- School of Pharmacy, Graduate Institute
of Medical Science, National Defense Medical Center, Taipei, Taiwan
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22
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Lavoie B, Lian JB, Mawe GM. Regulation of Bone Metabolism by Serotonin. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2018; 1033:35-46. [PMID: 29101650 DOI: 10.1007/978-3-319-66653-2_3] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
The processes of bone growth and turnover are tightly regulated by the actions of various signaling molecules, including hormones, growth factors, and cytokines. Imbalances in these processes can lead to skeletal disorders such as osteoporosis or high bone mass disease. It is becoming increasingly clear that serotonin can act through a number of mechanisms, and at different locations in the body, to influence the balance between bone formation and resorption. Its actions on bone metabolism can vary, based on its site of synthesis (central or peripheral) as well as the cells and subtypes of receptors that are activated. Within the central nervous system, serotonergic neurons act via the hypothalamus to suppress sympathetic input to the bone. Since sympathetic input inhibits bone formation, brain serotonin has a net positive effect on bone growth. Gut-derived serotonin is thought to inhibit bone growth by attenuating osteoblast proliferation via activation of receptors on pre-osteoblasts. There is also evidence that serotonin can be synthesized within the bone and act to modulate bone metabolism. Osteoblasts, osteoclasts, and osteocytes all have the machinery to synthesize serotonin, and they also express the serotonin-reuptake transporter (SERT). Understanding the roles of serotonin in the tightly balanced system of bone modeling and remodeling is a clinically relevant goal. This knowledge can clarify bone-related side effects of drugs that affect serotonin signaling, including serotonin-specific reuptake inhibitors (SSRIs) and receptor agonists and antagonists, and it can potentially lead to therapeutic approaches for alleviating bone pathologies.
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Affiliation(s)
- Brigitte Lavoie
- Department of Neurological Sciences, The University of Vermont, Burlington, VT, 05405, USA. .,The University of Vermont, D406 Given Building, Burlington, VT, 05405, USA.
| | - Jane B Lian
- Department of Biochemistry, The University of Vermont, Burlington, VT, 05405, USA
| | - Gary M Mawe
- Department of Neurological Sciences, The University of Vermont, Burlington, VT, 05405, USA
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23
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Briggs R, Kennelly SP, Kenny RA. Does baseline depression increase the risk of unexplained and accidental falls in a cohort of community-dwelling older people? Data from The Irish Longitudinal Study on Ageing (TILDA). Int J Geriatr Psychiatry 2018; 33:e205-e211. [PMID: 28766755 DOI: 10.1002/gps.4770] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Revised: 06/21/2017] [Accepted: 07/04/2017] [Indexed: 01/07/2023]
Abstract
BACKGROUND Depression independently increases the risk of falls in older people, but the mechanism for this relationship, as well as the specific falls type involved, remains unclear. Accidental falls (AFs) are due to slips or trips, while the cause of unexplained falls (UFs) is not immediately apparent and can include unrecognised syncope. METHOD This longitudinal study examines the relationship between baseline depression and subsequent falls, both accidental and unexplained, at 2-year follow-up in a cohort of community dwelling adults aged ≥50 years. Baseline depression was defined as a score ≥16 on The Centre for Epidemiological Studies Depression Scale. At follow-up, participants were assessed regarding falls since last interview. RESULTS One-third (228/647) of the depressed group had fallen at follow-up, compared with 22% (1388/6243) of the nondepressed group (P < .001). Multiple logistic regression models demonstrated that depression was associated with an odds ratio of 1.58 (1.31-1.89) P < .001; 1.24 (1.00-1.52), P = .046; and 1.89 (1.45-2.46), P < .001 for total falls, AFs and UFs, respectively, after controlling for relevant covariates. Participants with depression who fell were more likely to have prior falls, functional impairment and slower gait when compared with depressed participants who did not fall. DISCUSSION The risk of falls associated with depression in older adults is more marked for UFs, with the association for AFs approaching borderline significance only. This finding is important because UFs require focused clinical assessment with attention to potential causes such as cardiac arrhythmia or orthostatic hypotension.
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Affiliation(s)
- Robert Briggs
- The Irish Longitudinal Study on Ageing (TILDA), Trinity College Dublin, Dublin 2, Ireland.,Department of Medical Gerontology, Mercer's Institute for Successful Ageing, St. James Hospital, Dublin 8, Ireland.,Centre for Ageing, Neuroscience and the Humanities, Tallaght Hospital, Dublin 24, Ireland
| | - Sean P Kennelly
- Centre for Ageing, Neuroscience and the Humanities, Tallaght Hospital, Dublin 24, Ireland
| | - Rose Anne Kenny
- The Irish Longitudinal Study on Ageing (TILDA), Trinity College Dublin, Dublin 2, Ireland.,Department of Medical Gerontology, Mercer's Institute for Successful Ageing, St. James Hospital, Dublin 8, Ireland
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24
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Mollard E, Bilek L, Waltman N. Emerging evidence on the link between depressive symptoms and bone loss in postmenopausal women. Int J Womens Health 2017; 10:1-9. [PMID: 29343990 PMCID: PMC5749395 DOI: 10.2147/ijwh.s147006] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
Osteoporosis and depression are major health problems of crisis proportions in postmenopausal women. Researchers have established a relationship between bone loss and depression, although few studies have focused on postmenopausal women. The purposes of this integrative review were to synthesize and summarize the available literature on: 1) the associations between bone loss and depression in postmenopausal women; and 2) potential variables that impact the associations between bone loss and depression in postmenopausal women. After searching the databases PubMed, CINAHL, Embase, and the Cochrane library between 2007 and 2017, 12 articles met the inclusion criteria. The majority of the included studies supported the relationship between depression and bone loss in postmenopausal women, although little information is offered as to why this relationship exists. This review summarizes the research that has been completed on depression and bone loss in postmenopausal women and identifies gaps in the literature. These findings will aid in the planning of future research and the development of health care recommendations.
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Affiliation(s)
- Elizabeth Mollard
- College of Nursing, University of Nebraska Medical Center, Lincoln, NE
| | - Laura Bilek
- College of Allied Health Professionals, University of Nebraska Medical Center, Omaha, NE, USA
| | - Nancy Waltman
- College of Nursing, University of Nebraska Medical Center, Lincoln, NE
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25
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Hahn C, Oh JH, Joo SH, Jeong JE, Chae JH, Lee CU, Kim TS. Association between mental health status and bone mineral density: Analysis of the 2008-2010 Korea national health and nutrition examination survey. PLoS One 2017; 12:e0187425. [PMID: 29131866 PMCID: PMC5683604 DOI: 10.1371/journal.pone.0187425] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Accepted: 10/19/2017] [Indexed: 02/03/2023] Open
Abstract
The current study aimed to investigate the association between mental health status and bone mineral density (BMD) using data from the Korean National Health and Nutrition Examination Survey (KNHANES) 2008–2010. We enrolled 15,876 South Korean participants (4,010 postmenopausal females, 4,836 premenopausal females, and 7,016 males, all aged 20 years or older). BMD was measured using dual-energy radiography absorptiometry at the femoral neck (NK), lumbar spine (LSP), and total femur (TFM). Mental health status data were obtained from a self-report questionnaire that assessed psychological stress, depressed mood, and suicidal ideation. Psychological stress was negatively correlated with BMD in the LSP, NK, and TFM for the male group. Depressed mood was associated with lower BMD in the LSP, NK and TFM for the premenopausal female group, and in the LSP for the male group. Suicidal ideation was associated with lower BMD in the NK and TFM for the male group. Mental health problems were associated with lower BMD, especially in premenopausal females and males. Future investigations should focus on the shared pathophysiology between mental health problems and BMD, and the interrelationship between increased BMD and recovery from mental health problems.
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Affiliation(s)
- Changtae Hahn
- Department of Psychiatry, Daejeon St. Mary’s Hospital, College of Medicine, Catholic University of Korea, Deajeon, Republic of Korea
| | - Ji Hoon Oh
- Department of Psychiatry, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Soo-Hyun Joo
- Department of Psychiatry, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jo-Eun Jeong
- Department of Psychiatry, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jeong-Ho Chae
- Department of Psychiatry, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Chang-Uk Lee
- Department of Psychiatry, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Tae-Suk Kim
- Department of Psychiatry, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
- * E-mail:
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Bipolar disorder and the risk of fracture: A nationwide population-based cohort study. J Affect Disord 2017; 218:246-252. [PMID: 28477503 DOI: 10.1016/j.jad.2017.04.037] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2016] [Revised: 04/16/2017] [Accepted: 04/20/2017] [Indexed: 01/18/2023]
Abstract
BACKGROUND The co-primary aims are: 1) to compare the risk of fracture between adults with bipolar disorder and those without bipolar disorder; and 2) to assess whether lithium, anticonvulsants and antipsychotics reduce risk of fracture among individuals with bipolar disorder. METHODS The analysis herein is a population-based retrospective cohort study, utilizing the National Health Insurance (NHI) medical claims data collected between 1997 and 2013 in Taiwan. We identified 3705 cases with incident diagnoses of bipolar disorder during study period and 37,050 matched controls without bipolar diagnoses. Incident diagnosis of fracture was operationalized as any bone fracture after the diagnosis of bipolar disorder or after the matched index date for controls. RESULTS Bipolar patients had significantly higher risk of facture when compared to matched controls (17.6% versus 11.7%, respectively p<0.001). The hazard ratio (HR) was 1.33 (95% confidence interval [CI]=1.23-1.48, p<0.001) after adjusting for covariates. Persons with bipolar disorder and a prior history of psychiatric hospitalization were had higher risk for bone fracture than those without prior history of psychiatric hospitalization when compared to match controls. Higher cumulative dose of antipsychotics or mood stabilizers did not increase the risk of fracture. LIMITATIONS The diagnoses of bipolar disorder were not confirmed with structured clinical interview. Drug adherence, exact exposure dosage, smoking, lifestyle, nutrition and exercise habits were unable to be assessed in our dataset. CONCLUSIONS Bipolar disorder is associated with increased risk of fracture, and higher cumulative dose of mood stabilizers and antipsychotics did not further increase the risk of fracture.
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Lee S, Seo DH, Kim KM, Lee EY, Kim HC, Kim CO, Youm Y, Rhee Y. Contingent association between the size of the social support network and osteoporosis among Korean elderly women. PLoS One 2017; 12:e0180017. [PMID: 28700637 PMCID: PMC5507492 DOI: 10.1371/journal.pone.0180017] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Accepted: 06/08/2017] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To investigate the association between the number of personal ties (or the size of the social support network) and the incidence of osteoporosis among older women in Korea. METHODS Data from the Korean Urban Rural Elderly Study were used. Bone density was measured by dual-energy X-ray absorptiometry at the lumbar spine (L1-L4) and femur neck. T-score, the standardized bone density compared with what is normally expected in a healthy young adult, was measured and the presence of osteoporosis was determined, if the T-score was < -2.5. The social support network size was measured by self-responses (number of confidants and spouse). RESULTS Of the 1,846 participants, 44.9% were diagnosed with osteoporosis. The association between the social support network size and the incidence of osteoporosis was curvilinear in both bivariate and multivariate analyses. Having more people in one's social support network size was associated with lower risk of osteoporosis until it reached around four. Increasing the social support network size beyond four, in contrast, was associated with a higher risk of osteoporosis. This association was contingent on the average intimacy level of the social network. At the highest average intimacy level ("extremely close"), increasing the number of social support network members from one to six was associated with linear decrease in the predicted probability of osteoporosis from 45% to 30%. However, at the lowest average intimacy level ("not very close"), the predicted probability of osteoporosis dramatically increased from 48% to 80% as the size of the social network increased from one to six. CONCLUSION Our results show that maintaining a large and intimate social support network is associated with a lower risk of osteoporosis among elderly Korean women, while a large but less-intimate social relationship is associated with a higher risk.
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Affiliation(s)
- Seungwon Lee
- Department of Sociology, Yonsei University, Seoul, South Korea
| | - Da Hea Seo
- Department of Endocrinology and Metabolism, Inha University School of Medicine, Incheon, South Korea
| | - Kyoung Min Kim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Eun Young Lee
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea College of Medicine, Seoul, South Korea
| | - Hyeon Chang Kim
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, South Korea
| | - Chang Oh Kim
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, South Korea
| | - Yoosik Youm
- Department of Sociology, Yonsei University, Seoul, South Korea
| | - Yumie Rhee
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, South Korea
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Nahas ARF, Sulaiman SAS. Increased Risk of Osteoporosis in Depressive Patients with Erectile Dysfunction: A Cross-sectional Study from Malaysia. JOURNAL OF PHARMACY AND BIOALLIED SCIENCES 2017; 9:178-184. [PMID: 28979072 PMCID: PMC5621180 DOI: 10.4103/jpbs.jpbs_64_17] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Depression imposes numerous changes on depressive men, promoting for low bone mineral density (BMD) and erectile dysfunction (ED), yet no published data on exploring the possible association between these two disorders among depressive men. We therefore investigated whether low BMD is associated with ED among depressive men and highlighted the possible mutual underlying factors that might give rise to these two disorders in this specific group of patients. MATERIALS AND METHODS In this cross-sectional study, 119 depressive men were recruited and their sociodemographic and clinical characteristics were obtained. Erectile function was evaluated using the 5-item International Index of Erectile Function. All patients received a calcaneal BMD scanning. Chi-square test was conducted to determine if a significant association exists between ED and low BMD. RESULTS Of the study participants, ninety patients reported ED, while 29 patients reported no ED. Within the ED group, there was a significantly higher proportion of patients with low BMD compared to the non-ED group (85.6% vs. 62.1%, P = 0.006). In addition, among younger participants (i.e., aged < 50 years old), the difference in T-score between ED patients (Md = -2.2, n = 41) and non-ED patients (Md = -1.3, n = 20) was significant (P = 0.001); but held no significance among older participants. CONCLUSIONS While our findings are considered prefatory, we reported that low BMD was significantly associated with ED in depressive men and that only among young depressive patients, BMD was significantly lower in ED patients compared to non-ED patients. More research investigating these findings and the possible underlying mechanisms for such association are warranted.
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Affiliation(s)
- Abdul Rahman Fata Nahas
- Discipline of Clinical Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, Pahang, Malaysia
- Department of Pharmacy Practice, Kulliyyah of Pharmacy, International Islamic University Malaysia, Pahang, Malaysia
| | - Syed Azhar Syed Sulaiman
- Discipline of Clinical Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, Pahang, Malaysia
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Abstract
Serotonin was first discovered in the gut, and its conventional actions as an intercellular signalling molecule in the intrinsic and extrinsic enteric reflexes are well recognized, as are a number of serotonin signalling pharmacotherapeutic targets for treatment of nausea, diarrhoea or constipation. The latest discoveries have greatly broadened our understanding of non-conventional actions of peripheral serotonin within the gastrointestinal tract and in a number of other tissues. For example, it is now clear that bacteria within the lumen of the bowel influence serotonin synthesis and release by enterochromaffin cells. Also, serotonin can act both as a pro-inflammatory and anti-inflammatory signalling molecule in the intestinal mucosa via activation of serotonin receptors (5-HT7 or 5-HT4 receptors, respectively). For decades, serotonin receptors have been known to exist in a variety of tissues other than the gut, but studies have now provided strong evidence for physiological roles of serotonin in several important processes, including haematopoiesis, metabolic homeostasis and bone metabolism. Furthermore, evidence for serotonin synthesis in peripheral tissues outside of the gut is emerging. In this Review, we expand the discussion beyond gastrointestinal functions to highlight the roles of peripheral serotonin in colitis, haematopoiesis, energy and bone metabolism, and how serotonin is influenced by the gut microbiota.
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Barandun J. [Not Available]. PRAXIS 2017; 106:465-469. [PMID: 28443715 DOI: 10.1024/1661-8157/a002659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Zusammenfassung. Die chronisch obstruktive Lungenkrankheit (COPD) wird weltweit häufiger. Der Hauptrisikofaktor in unseren Breitengraden ist das Zigarettenrauchen. Rauchen führt zur chronischen Bronchitis und zu einer COPD und/oder einem Lungenemphysem. Die initiale Abklärung ist einfach und erfolgt mittels Spirometrie in der hausärztlichen Praxis. Die Einteilung der COPD erfolgt anhand der COPD-GOLD-Richtlinien, mit dem lungenfunktionellen Obstruktionsgrad und den Symptomen bzw. der Exazerbationshäufigkeit. Therapeutisch muss immer ein Nikotinstopp erreicht werden. Regelmässige körperliche Betätigung, bzw. eine pulmonale Rehabilitation, sind sinnvoll. Medikamentös wird vor allem inhalativ behandelt. Im Vordergrund steht die Bronchodilatationstherapie. Da viele neue Medikamente auf dem Markt sind, muss der Hausarzt die Handhabung der Inhalationsgeräte und die Wirkung der Inhalationsmedikamente gut kennen. Korrekte Instruktionen und Anleitungen zu einem Selbstmanagement-Programm sind für den Therapieerfolg entscheidend.
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Wippert PM, Rector M, Kuhn G, Wuertz-Kozak K. Stress and Alterations in Bones: An Interdisciplinary Perspective. Front Endocrinol (Lausanne) 2017; 8:96. [PMID: 28507534 PMCID: PMC5410657 DOI: 10.3389/fendo.2017.00096] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Accepted: 04/18/2017] [Indexed: 11/29/2022] Open
Abstract
Decades of research have demonstrated that physical stress (PS) stimulates bone remodeling and affects bone structure and function through complex mechanotransduction mechanisms. Recent research has laid ground to the hypothesis that mental stress (MS) also influences bone biology, eventually leading to osteoporosis and increased bone fracture risk. These effects are likely exerted by modulation of hypothalamic-pituitary-adrenal axis activity, resulting in an altered release of growth hormones, glucocorticoids and cytokines, as demonstrated in human and animal studies. Furthermore, molecular cross talk between mental and PS is thought to exist, with either synergistic or preventative effects on bone disease progression depending on the characteristics of the applied stressor. This mini review will explain the emerging concept of MS as an important player in bone adaptation and its potential cross talk with PS by summarizing the current state of knowledge, highlighting newly evolving notions (such as intergenerational transmission of stress and its epigenetic modifications affecting bone) and proposing new research directions.
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Affiliation(s)
- Pia-Maria Wippert
- Department of Health Sciences, Institute of Sociology of Health and Physical Activity, University of Potsdam, Potsdam, Germany
- Department of Health Sciences and Technology, Institute for Biomechanics, ETH Zurich, Zurich, Switzerland
- *Correspondence: Pia-Maria Wippert,
| | - Michael Rector
- Department of Health Sciences, Institute of Sociology of Health and Physical Activity, University of Potsdam, Potsdam, Germany
| | - Gisela Kuhn
- Department of Health Sciences and Technology, Institute for Biomechanics, ETH Zurich, Zurich, Switzerland
| | - Karin Wuertz-Kozak
- Department of Health Sciences, Institute of Sociology of Health and Physical Activity, University of Potsdam, Potsdam, Germany
- Department of Health Sciences and Technology, Institute for Biomechanics, ETH Zurich, Zurich, Switzerland
- Schön Klinik München Harlaching, Munich, Germany
- Spine Center, Academic Teaching Hospital and Spine Research Institute, Paracelsus Private Medical University Salzburg, Salzburg, Austria
- Competence Center for Applied Biotechnology and Molecular Medicine (CABMM), University of Zurich, Zurich, Switzerland
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Cheng BH, Chen PC, Yang YH, Lee CP, Huang KE, Chen VC. Effects of depression and antidepressant medications on hip fracture: A population-based cohort study in Taiwan. Medicine (Baltimore) 2016; 95:e4655. [PMID: 27603358 PMCID: PMC5023880 DOI: 10.1097/md.0000000000004655] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
This study was conducted to investigate the effects of depression and antidepressant medications on hip fracture. The database of the Taiwan National Health Insurance with medical records of more than 1,000,000 individuals was searched for patients who had hip fracture with or without depression from 1998 to 2009. Patients with the following conditions were excluded: hip fracture due to cancer or traffic accidents, hip fracture that occurred before the diagnosis of depression, and use of antidepressants before the diagnosis of depression. A matched cohort of 139,110 patients was investigated, including 27,822 (17,309 females; 10,513 males) with depression and 111,288 (69,236 females; 42,052 males) without depression (1:4 randomly matched with age, sex, and index date). Among these patients, 232 (158 females and 74 males) had both hip fracture and depression, and 690 (473 females and 217 males) had hip fracture only. The Cox proportional-hazards regression method was used to determine the effect of depression on hip fracture. The hazard ratio (HR) for each clinical parameter was calculated after adjusting for confounders including sex, age, Charlson comorbidity index, urbanization, osteoporosis, and antidepressants. Results showed that patients with major depressive disorder had a 61% higher incidence of hip fracture than those without depression (HR 1.61, 95% confidence interval [CI] 1.19-2.18, P = 0.002). The risk of hip fracture for patients with less severe depressive disorder (dysthymia or depressive disorder, not otherwise specified) was not statistically higher than that of patients with no depression (HR 1.10, 95% CI = 0.91-1.34, P = 0.327). Among the patients with depression, females had a 49% higher incidence for hip fracture than males (HR 1.49, 95% CI 1.30-1.72, P < 0.001). The incidence of hip fracture also increased with age and Charlson comorbidity index scores. Analyses of both all (139,110) patients and only patients (27,822) with depression revealed that antidepressants had no negative impact on the incidence of hip fracture. In conclusion, major depression was found to be a risk factor for hip fracture and that use of antidepressants had no adverse effect on hip fracture in the Taiwanese population.
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Affiliation(s)
- Bi-Hua Cheng
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Chiayi
| | - Pau-Chung Chen
- Institute of Occupational Medicine and Industrial Hygiene, National Taiwan University, Taipei
| | | | - Chuan-Pin Lee
- Center of Excellence for Chang Gung Research Data Link, Chang Gung Memorial Hospital, Chiayi
| | - Ko-En Huang
- Department of Obstetrics and Gynecology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine
- Correspondence: Vincent C. Chen, Chang Gung Medical Foundation, Chang Gung Memorial Hospital, Chiayi, Taiwan (e-mail: ); Ko-En Huang, Department of Obstetrics and Gynecology, Kaohsiung Chang Gung Memorial Hospital, Taiwan (e-mail: )
| | - Vincent C. Chen
- Chang Gung Medical Foundation, Chang Gung Memorial Hospital, Chiayi, Taiwan
- Correspondence: Vincent C. Chen, Chang Gung Medical Foundation, Chang Gung Memorial Hospital, Chiayi, Taiwan (e-mail: ); Ko-En Huang, Department of Obstetrics and Gynecology, Kaohsiung Chang Gung Memorial Hospital, Taiwan (e-mail: )
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Rauma PH, Honkanen RJ, Williams LJ, Tuppurainen MT, Kröger HP, Koivumaa-Honkanen H. Effects of antidepressants on postmenopausal bone loss - A 5-year longitudinal study from the OSTPRE cohort. Bone 2016; 89:25-31. [PMID: 27179631 DOI: 10.1016/j.bone.2016.05.003] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Revised: 04/16/2016] [Accepted: 05/10/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND Osteoporosis and depression are major health problems worldwide. The association between antidepressants, a treatment for depression, and bone health needs more detailed exploration. OBJECTIVE The present study investigates antidepressant medication use and postmenopausal bone loss over time. METHODS A total of 1988 women (aged 57-67) participating in the Kuopio Osteoporosis Risk Factor and Prevention Study (OSTPRE) cohort responded to a postal enquiry and had their femoral neck bone mineral density (BMD) measured in 1999 and again in 2004. Data on antidepressant use was obtained from the National Prescription Register. Multiple regression techniques were used to test the associations, before and after adjustment for anthropometric, medical, physical and lifestyle factors. RESULTS Over the five years of follow-up, 319 (16.0%) women purchased antidepressants. Mean baseline femoral neck BMD for the entire study group was 881mg/cm(2) (SD 123) and mean 5-year bone loss was 6.0mg/cm(2) (SD 4.7). After adjustments, users of tricyclic antidepressants (TCA) had greater annual BMD loss than non-users (-3.6mg/cm(2) vs. -1.1mg/cm(2); P=0.031). Accelerated bone loss was also associated with selective serotonin reuptake inhibitor's (SSRI) use (P=0.001) and use of other antidepressants in a dose-response way, with the latter only among women of low-weight and normal-weight women who had lost weight over the study period. CONCLUSIONS In conclusion, the use of SSRIs seems to accelerate postmenopausal bone loss in a dose-response manner. Associations between TCA and other antidepressant use and bone loss may also exist. Thus, the possibility of increased risk of osteoporosis should be considered when prescribing antidepressants for postmenopausal women.
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Affiliation(s)
- Päivi H Rauma
- Social Pharmacy, School of Pharmacy, Faculty of Health Sciences, University of Eastern Finland (UEF), Kuopio, Finland; The Kuopio Musculoskeletal Reseach Unit, Clinical Research Center, Institute of Clinical Medicine, UEF, Kuopio, Finland.
| | - Risto J Honkanen
- The Kuopio Musculoskeletal Reseach Unit, Clinical Research Center, Institute of Clinical Medicine, UEF, Kuopio, Finland.
| | | | - Marjo T Tuppurainen
- The Kuopio Musculoskeletal Reseach Unit, Clinical Research Center, Institute of Clinical Medicine, UEF, Kuopio, Finland; Department of Obstetrics and Gynaecology, Kuopio University Hospital (KUH), Kuopio, Finland.
| | - Heikki P Kröger
- The Kuopio Musculoskeletal Reseach Unit, Clinical Research Center, Institute of Clinical Medicine, UEF, Kuopio, Finland; Department of Orthopaedics, Traumatology and Handsurgery, KUH, Kuopio, Finland.
| | - Heli Koivumaa-Honkanen
- Institute of Clinical Medicine, Psychiatry, UEF, Kuopio, Finland; Department of Psychiatry, KUH, Kuopio, Finland; Department of Psychiatry, South-Savonia Hospital District, Mikkeli, Finland; Department of Psychiatry, North Karelia Central Hospital, Joensuu, Finland; Department of Psychiatry, SOSTERI, Savonlinna, Finland; Department of Psychiatry, SOTE, Iisalmi, Finland; Department of Psychiatry, Lapland Central Hospital, Rovaniemi, Finland; Department of Child Psychiatry, University of Oulu, Finland.
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Schweiger JU, Schweiger U, Hüppe M, Kahl KG, Greggersen W, Fassbinder E. Bone density and depressive disorder: a meta-analysis. Brain Behav 2016; 6:e00489. [PMID: 27547495 PMCID: PMC4980464 DOI: 10.1002/brb3.489] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Revised: 03/13/2016] [Accepted: 04/01/2016] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND The aim of this study was to evaluate the evidence of low bone mineral density (BMD) in depression. Low BMD is a major risk factor for osteoporotic fractures and frailty. METHODS The searched database was Pubmed, Meta-analysis included human studies in men and women fulfilling the following criteria: (1) assessment of BMD in the lumbar spine, the femur or the total hip; (2) comparison of BMD between depressed individuals and the healthy control group; (3) measurement of BMD using dual-energy X-ray absorptiometry (DEXA); and (4) data on the mean, standard deviation, or standard error of BMD. RESULTS Twenty-one studies were identified, encompassing 1842 depressed and 17,401 nondepressed individuals. Significant negative composite weighted mean effect sizes were identified for the lumbar spine (d = -0.15, 95%CL -0.22 to -0.08), femur (d = -0.34, 95%CL -0.64 to -0.05), and total hip (d = -0.14, 95%CL -0.23 to -0.05) indicating low BMD in depression. Examining men and women shows low bone density in the lumbar spine and femur in women and low bone density in the hip in men. The differences between men and women with MDD and the comparison group tended to be higher when examined by expert interviewers. Low bone density was found in all age groups. CONCLUSIONS Bone mineral density is reduced in patients with depressive disorders. The studies provide little evidence for potential relevant mediating factors.
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Affiliation(s)
| | - Ulrich Schweiger
- Department of Psychiatry and Psychotherapy Lübeck University Medical School Lübeck Germany
| | - Michael Hüppe
- Department of Anesthesiology Lübeck University Medical School Lübeck Germany
| | - Kai G Kahl
- Department of Psychiatry, Social Psychiatry and Psychotherapy Hannover Medical School Hannover Germany
| | - Wiebke Greggersen
- Department of Psychiatry and Psychotherapy Lübeck University Medical School Lübeck Germany
| | - Eva Fassbinder
- Department of Psychiatry and Psychotherapy Lübeck University Medical School Lübeck Germany
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Fernandes BS, Hodge JM, Pasco JA, Berk M, Williams LJ. Effects of Depression and Serotonergic Antidepressants on Bone: Mechanisms and Implications for the Treatment of Depression. Drugs Aging 2016; 33:21-5. [PMID: 26547857 DOI: 10.1007/s40266-015-0323-4] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Osteoporosis is a chronic skeletal disease marked by microarchitectural deterioration of the bone matrix and depletion of bone mineral density (BMD), with a consequent increased risk for fragility fractures. It has been frequently associated with depression, which is also a chronic and debilitating disorder with high prevalence. Selective serotonin reuptake inhibitors (SSRIs), first-line agents in the pharmacological treatment of mood and anxiety disorders, have also been shown to negatively affect bone metabolism. SSRIs are the most prescribed antidepressants worldwide and a large number of persons at risk of developing osteoporosis, including older patients, will receive these antidepressants. Therefore, a proper musculoskeletal evaluation of individuals who are being targeted for or using SSRIs is a priority. The aim of this article is to review the evidence regarding the effects of depression and serotonergic antidepressants on bone and its implications for clinical care.
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Affiliation(s)
- Brisa S Fernandes
- IMPACT Strategic Research Centre, School of Medicine, Deakin University, PO Box 281, Geelong, VIC, 3220, Australia.,Laboratory of Calcium Binding Proteins in the Central Nervous System, Department of Biochemistry, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Jason M Hodge
- Barwon Biomedical Research, Barwon Health University Hospital, Geelong, VIC, Australia.,MMR Strategic Research Centre, School of Medicine, Deakin University, Geelong, VIC, Australia
| | - Julie A Pasco
- IMPACT Strategic Research Centre, School of Medicine, Deakin University, PO Box 281, Geelong, VIC, 3220, Australia.,Department of Medicine, The University of Melbourne, St Albans, VIC, Australia
| | - Michael Berk
- IMPACT Strategic Research Centre, School of Medicine, Deakin University, PO Box 281, Geelong, VIC, 3220, Australia.,Florey Institute for Neuroscience and Mental Health, Department of Psychiatry and Orygen, The National Centre of Excellence in Youth Mental Health, University of Melbourne, Parkville, Australia
| | - Lana J Williams
- IMPACT Strategic Research Centre, School of Medicine, Deakin University, PO Box 281, Geelong, VIC, 3220, Australia.
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Bener A, Saleh NM, Bhugra D. Depressive symptoms and bone mineral density in menopause and postmenopausal women: A still increasing and neglected problem. J Family Med Prim Care 2016; 5:143-9. [PMID: 27453860 PMCID: PMC4943122 DOI: 10.4103/2249-4863.184640] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
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. Materials and 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/m2) 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. Conclusion: 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.
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Affiliation(s)
- Abdulbari Bener
- 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
| | - Najah M Saleh
- Department of Obstetrics and Gynecology, Women's Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Dinesh Bhugra
- Department of Evidence for Population Health, Section of Cultural Psychiatry, Institute of Psychiatry, King's College London, Maudsley Hospital, UK
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Abstract
Osteoporosis, the most common metabolic skeletal disease, is characterized by decreased bone mass and deteriorated bone quality, leading to increased fracture risk. With the aging of the population, osteoporotic fracture is an important public health issue. Organisms are constantly exposed to various stressful stimuli that affect physiological processes. Recent studies showed that chronic psychological stress is a risk factor for osteoporosis by various signaling pathways. The purpose of this article is to review the recent progress of the association between chronic psychological stress and osteoporosis. Increasing evidence confirms the physiological importance of the central nervous system, especially the hypothalamus, in the regulation of bone metabolism. Both animal and human studies indicate that chronic psychological stress induces a decrease of bone mass and deterioration of bone quality by influencing the hypothalamic-pituitary-adrenocortical (HPA) axis, sympathetic nervous system, and other endocrine, immune factors. Active mastication, proven to be an effective stress-coping behavior, can attenuate stress-induced neuroendocrine responses and ameliorate stress-induced bone loss. Therefore, active mastication may represent a useful approach in preventing and/or treating chronic stress-associated osteoporosis. We also discuss several potential mechanisms involved in the interaction between chronic stress, mastication and osteoporosis. Chronic stress activates the HPA axis and sympathetic nervous system, suppresses the secretion of gonadal hormone and growth hormone, and increases inflammatory cytokines, eventually leading to bone loss by inhibiting bone formation and stimulating bone resorption.
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Sheu YH, Lanteigne A, Stürmer T, Pate V, Azrael D, Miller M. SSRI use and risk of fractures among perimenopausal women without mental disorders. Inj Prev 2015; 21:397-403. [PMID: 26113668 DOI: 10.1136/injuryprev-2014-041483] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2014] [Accepted: 04/17/2015] [Indexed: 11/04/2022]
Abstract
BACKGROUND Selective serotonin reuptake inhibitors (SSRIs) were recently approved by the FDA to treat vasomotor symptoms associated with menopause. No prior study has directly examined whether fracture risk is increased among perimenopausal women who initiate SSRIs or among a population of women without mental disorders more generally. METHODS Female patients without mental illness, aged 40-64 years, who initiated SSRIs were compared with a cohort who initiated H2 antagonists (H2As) or proton-pump inhibitors (PPIs) in 1998-2010, using data from a claims database. Standardised mortality ratio weighting was applied using the propensity score odds of treatment to adapt the distribution of characteristics among patients starting H2A/PPIs to the distribution among SSRI initiators. Poisson regression estimated risk differences and Cox proportional hazards regression the RR of fractures among new users of SSRIs versus H2A/PPIs. Primary analyses allowed for a 6-month lag period (ie, exposure begins 6 months after initiation) to account for a hypothesised delay in the onset of any clinically meaningful effect of SSRIs on bone mineral density. RESULTS Fracture rates were higher among the 137,031 SSRI initiators compared with the 236,294 H2A/PPI initiators, with HRs (SSRI vs H2A/PPI) over 1, 2 and 5 years of 1.76 (95% CI 1.33 to 2.32), 1.73 (95% CI 1.33 to 2.24) and 1.67 (95% CI 1.30 to 2.14), respectively. CONCLUSIONS SSRIs appear to increase fracture risk among middle-aged women without psychiatric disorders, an effect sustained over time, suggesting that shorter duration of treatment may decrease fracture risk. Future efforts should examine whether this association pertains at lower doses.
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Affiliation(s)
- Yi-han Sheu
- Department of Epidemiology, Harvard University, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Amy Lanteigne
- Department of Social and Behavioral Sciences, Harvard University, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Til Stürmer
- Department of Epidemiology, University of North Carolina at Chapel Hill, Gillings School of Global Public Health, Chapel Hill, North Carolina, USA
| | - Virginia Pate
- Department of Epidemiology, University of North Carolina at Chapel Hill, Gillings School of Global Public Health, Chapel Hill, North Carolina, USA
| | - Deborah Azrael
- Department of Health Policy and Management, Harvard University, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Matthew Miller
- Department of Epidemiology, Harvard University, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA Department of Health Policy and Management, Harvard University, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA Department of Health Sciences, Northeastern University, Boston, Massachusetts, USA
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Rauma PH, Pasco JA, Berk M, Stuart AL, Koivumaa-Honkanen H, Honkanen RJ, Hodge JM, Williams LJ. The association between use of antidepressants and bone quality using quantitative heel ultrasound. Aust N Z J Psychiatry 2015; 49:437-43. [PMID: 25586753 DOI: 10.1177/0004867414565475] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
OBJECTIVE Osteoporosis and depression are major public health problems worldwide. Studies have reported an association between antidepressant use, mainly selective serotonin reuptake inhibitors (SSRIs), and bone mineral density (BMD), but the issue remains unclear. METHODS This study examined data collected from 849 Australian men (aged 24-98 years) participating in the Geelong Osteoporosis Study (GOS). Bone quality was determined using quantitative ultrasound (QUS) and included the following parameters: Broadband Ultrasound Attenuation (BUA), Speed of Sound (SOS) and Stiffness Index (SI). Anthropometry, socio-economic status (SES), medication use and lifestyle factors were determined. The cross-sectional associations between bone quality and use of antidepressants were studied using multivariate linear regression adjusted for potential confounders. RESULTS At the time of assessment, 61 (7.2%) men were using antidepressants, of which 44 (72.1%) used SSRIs. Antidepressant use was associated with lower SI (p = .002), SOS (p = .010) and BUA (p = .053). However, body weight was identified as an effect modifier; QUS values were lower for antidepressant users with lower weight (< 90 kg) only. CONCLUSIONS Use of antidepressants was associated with lower QUS values for men with low body weights. Thus, the risk of osteoporosis should be taken into account when prescribing antidepressants, in particular among men who are in this weight category.
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Affiliation(s)
- Päivi H Rauma
- Social Pharmacy, School of Pharmacy, University of Eastern Finland (UEF), Kuopio, Finland Bone and Cartilage Research Unit, Institute of Clinical Medicine, UEF, Kuopio, Finland
| | - Julie A Pasco
- School of Medicine, Deakin University, Geelong, Australia North West Academic Centre, Department of Medicine, The University of Melbourne, St Albans, Australia
| | - Michael Berk
- School of Medicine, Deakin University, Geelong, Australia The Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Parkville, Australia
| | | | - Heli Koivumaa-Honkanen
- Institute of Clinical Medicine, Psychiatry, UEF, Kuopio, Finland Departments of Psychiatry, Kuopio University Hospital, South-Savonia Hospital District, Mikkeli; North Karelia Central Hospital, Joensuu; SOSTERI, Savonlinna; SOTE, Iisalmi; Lapland Hospital District, Rovaniemi, Finland
| | - Risto J Honkanen
- Bone and Cartilage Research Unit, Institute of Clinical Medicine, UEF, Kuopio, Finland
| | - Jason M Hodge
- School of Medicine, Deakin University, Geelong, Australia Barwon Biomedical Research, The Geelong Hospital, Geelong, Australia
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Needham B, Mezuk B, Bareis N, Lin J, Blackburn E, Epel E. Depression, anxiety and telomere length in young adults: evidence from the National Health and Nutrition Examination Survey. Mol Psychiatry 2015; 20:520-8. [PMID: 25178165 PMCID: PMC4346549 DOI: 10.1038/mp.2014.89] [Citation(s) in RCA: 97] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2014] [Revised: 06/13/2014] [Accepted: 06/23/2014] [Indexed: 01/01/2023]
Abstract
Telomere length has been hypothesized to be a marker of cumulative exposure to stress, and stress is an established cause of depression and anxiety disorders. The aim of this study was to examine the relationship between depression, anxiety and telomere length, and to assess whether this relationship is moderated by race/ethnicity, gender and/or antidepressant use. Data were from the 1999-2002 National Health and Nutrition Examination Survey. Telomere length was assessed using the quantitative PCR method of telomere length relative to standard reference DNA. Past-year major depression (MD), generalized anxiety disorder (GAD) and panic disorder (PD), as well as depressed affect and anxious affect, were assessed using the Composite International Diagnostic Inventory (N=1290). Multiple linear regression was used to assess the relationship between depression and anxiety disorders and telomere length. Among women, those with GAD or PD had shorter telomeres than those with no anxious affect (β: -0.07, P<0.01), but there was no relationship among men (β: 0.08, P>0.05). Among respondents currently taking an antidepressant, those with MD had shorter telomeres than those without (β: -0.26, P<0.05), but there was no association between MD and telomere length among those not using antidepressants (β: -0.00, P>0.05). Neither depressive nor anxiety disorders were directly associated with telomere length in young adults. There was suggestive evidence that pharmacologically treated MD is associated with shorter telomere length, likely reflecting the more severe nature of MD that has come to clinical attention.
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Affiliation(s)
- Belinda Needham
- Department of Epidemiology, University of Michigan School of Public Health
| | - Briana Mezuk
- Division of Epidemiology, Department of Family Medicine and Population Health, Virginia Commonwealth University School of Medicine,Institute for Social Research, University of Michigan
| | - Natalie Bareis
- Division of Epidemiology, Department of Family Medicine and Population Health, Virginia Commonwealth University School of Medicine
| | - Jue Lin
- Department of Biochemistry and Biophysics, University of California, San Francisco
| | - Elizabeth Blackburn
- Department of Biochemistry and Biophysics, University of California, San Francisco
| | - Elissa Epel
- Department of Psychiatry, University of California, San Francisco
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Gougeon L, Payette H, Morais J, Gaudreau P, Shatenstein B, Gray-Donald K. Dietary patterns and incidence of depression in a cohort of community-dwelling older Canadians. J Nutr Health Aging 2015; 19:431-6. [PMID: 25809807 DOI: 10.1007/s12603-014-0562-9] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVES To investigate the association of dietary patterns with a 3-year incidence of depression among healthy older adults. DESIGN Multiple logistic regression models adjusted for age, sex, marital status, smoking, education, total energy intake, physical activity, body mass index, hypertension, functional autonomy, cognitive functioning, social activities, and stressful life events. Energy and macronutrient intakes were also analyzed as potential predictors of depression. SETTING Cities of Montréal, Laval, and Sherbrooke in Quebec, CA. PARTICIPANTS Community-dwelling older adults, free of depression at baseline (N=1,358, 67-84 y), followed for 3y in the Québec Longitudinal Study on Nutrition and Aging (NuAge). MEASUREMENTS Dietary patterns derived from principal components analysis of three 24 h-recalls at baseline, and depression incidence as measured by the 30-item Geriatric Depression Scale (≥11) and/or use of antidepressants at follow-up years. RESULTS 170 people (63% women) became depressed over the 3 years. People in the highest tertile of adherence to the "varied diet" had lower risk of depression before adjustment (OR 0.58, 98% C.I. 0.38-0.86) but not significant once age and sex were controlled. No other dietary pattern was associated with the incidence of depression. The highest tertile of energy intake was associated with lower depression incidence after controlling for all confounders (OR 0.55, 95%CI 0.34-0.87). CONCLUSION Among healthy older adults, dietary patterns do not appear to be related to depression. Those who eat less, however, possibly reflecting declining health, are at higher risk of becoming depressed.
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Affiliation(s)
- L Gougeon
- Dr. Katherine Gray-Donald, School of Dietetics and Human Nutrition, Macdonald-Stewart Building MS 2-035, McGill University, 21111 Lakeshore Road, Ste-Anne-de-Bellevue, Quebec, Canada, H9X 3V9. Tel.: 514-398-7677, Fax: 398-7739, E-mail:
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Salinas-Rodríguez A, Torres-Pereda MDP, Manrique-Espinoza B, Moreno-Tamayo K, Téllez-Rojo Solís MM. Impact of the non-contributory social pension program 70 y más on older adults' mental well-being. PLoS One 2014; 9:e113085. [PMID: 25409468 PMCID: PMC4237374 DOI: 10.1371/journal.pone.0113085] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2014] [Accepted: 10/19/2014] [Indexed: 11/28/2022] Open
Abstract
Background In 2007, a non-contributory pension program was launched in rural areas of Mexico. The program consisted in a non-conditional cash transfer of US$40 monthly to all older adults (OA) aged 70 and over. We evaluate the effect of the program on mental well-being of its beneficiaries. Methods and Findings Quantitative and qualitative methods were used. For the quantitative component, we used the selection criteria established by the program (age and locality size) to form the Intervention (OA aged 70–74 residing in rural localities, <2500 inhabitants) and Control groups (OA aged 70–74, in localities with 2501–2700 inhabitants). Baseline data collection was conducted in 2007 where 5,465 OA were interviewed. The follow-up survey was conducted in 2008, and it was possible to interview 5,270 OA, with a response rate of 96%. A difference-in-difference linear probability model with individual fixed effect was used to estimate the impact of the program on mental well-being indicators. In 2009 a qualitative component was designed to explore possible causal pathways of such effect. Results After a year of exposure, the program had a significant effect on reduction of depressive symptoms (β = −0.06, CI95% −0.12; −0.01) and an increase in empowerment indicators: OA participated in important household decisions (β = 0.09, CI95% 0.03;0.15); and OA participated in household decisions pertaining to expenses (β = 0.11, CI95% 0.05;0.18). Qualitative analysis found a strong trend showing a reduction of sadness, and feeling of increasing empowerment. Conclusions These results suggest that a non-conditional transfer in older ages have an impact beyond the economic sphere, impacting even the mental well-being. This effect could be explained because the pension produces feelings of safety and welfare. It is recommendable that governments should invest efforts towards universalizing the non-contributory pension programs in order to ensure a basic income for the elderly.
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Affiliation(s)
- Aarón Salinas-Rodríguez
- Center for Evaluation Research and Surveys, National Institute of Public Health, Cuernavaca, Mexico
| | | | - Betty Manrique-Espinoza
- Center for Evaluation Research and Surveys, National Institute of Public Health, Cuernavaca, Mexico
- * E-mail:
| | - Karla Moreno-Tamayo
- Center for Evaluation Research and Surveys, National Institute of Public Health, Cuernavaca, Mexico
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Rauma PH, Koivumaa-Honkanen H, Williams LJ, Tuppurainen MT, Kröger HP, Honkanen RJ. Life satisfaction and bone mineral density among postmenopausal women: cross-sectional and longitudinal associations. Psychosom Med 2014; 76:709-15. [PMID: 25373893 DOI: 10.1097/psy.0000000000000114] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVE The purpose of this study was to determine whether and how global life satisfaction is associated with bone mineral density (BMD) and bone loss. METHODS A total of 2167 women from a cohort of Finnish women born in 1932 to 1941 were included in the cross-sectional and 1147 women in the 10-year longitudinal part of the present study. Participants responded to a postal enquiry and underwent femoral BMD densitometry in 1999 (baseline) and 2009 (follow-up). During the follow-up, their life satisfaction was repeatedly measured using a four-item scale. Self-reported data on health, life-style, and medication were used to adjust the multivariate linear regression models. RESULTS Mean (standard deviation) femoral BMD decreased over the 10-year follow-up from 880 (125) to 846 (122) mg/cm. In the multivariate model, life satisfaction (p = .028) and its improvement (p = .001) predicted reduced bone loss, whereas hospitalization due to depression predicted increased bone loss (B = -0.523 annual % change, standard error = 0.212, p = .014). These effects were independent of each other. CONCLUSIONS Easily assessed global life satisfaction should be taken into account when effects of aging and prevention of osteoporosis as well as health promotion in postmenopausal women are considered.
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Affiliation(s)
- Päivi H Rauma
- From the Social Pharmacy (P.H.R.), School of Pharmacy, Faculty of Health Sciences, University of Eastern Finland (UEF), Kuopio, Finland; Bone and Cartilage Research Unit (P.H.R., M.T.T., H.P.K., R.J.H.), Surgery, Institute of Clinical Medicine, UEF, Kuopio, Finland; Institute of Clinical Medicine (H.K.-H.), Psychiatry, UEF, Kuopio, Finland; Clinic of Child Psychiatry (H.K.-H.), Oulu University Hospital, Oulu, Finland; Department of Psychiatry (H.K.-H.), Kuopio University Hospital (KUH), Kuopio, Finland; South-Savonia Hospital District (H.K.-H.), Mikkeli, Finland; North Karelia Central Hospital (H.K.-H.), Joensuu, Finland; SOSTERI (H.K.-H), Savonlinna, Finland; SOTE (H.K.-H), Iisalmi, Finland; Lapland Hospital District (H.K.-H.), Rovaniemi, Finland; University of Oulu (H.K.-H.), Oulu, Finland; School of Medicine (L.J.W.), Deakin University, Geelong, Australia; Department of Psychiatry (L.J.W.), The University of Melbourne, Parkville, Australia; Departments of Obstetrics and Gynaecology (M.T.T.) and Orthopaedics, Traumatology and Handsurgery (H.P.K.), KUH, Kuopio, Finland; and Institute of Public Health and Clinical Nutrition (R.J.H.), UEF, Kuopio, Finland
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Baldock PA, Lin S, Zhang L, Karl T, Shi Y, Driessler F, Zengin A, Hörmer B, Lee NJ, Wong IPL, Lin EJD, Enriquez RF, Stehrer B, During MJ, Yulyaningsih E, Zolotukhin S, Ruohonen ST, Savontaus E, Sainsbury A, Herzog H. Neuropeptide y attenuates stress-induced bone loss through suppression of noradrenaline circuits. J Bone Miner Res 2014; 29:2238-49. [PMID: 24535841 DOI: 10.1002/jbmr.2205] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2013] [Revised: 02/09/2014] [Accepted: 02/12/2014] [Indexed: 12/23/2022]
Abstract
Chronic stress and depression have adverse consequences on many organ systems, including the skeleton, but the mechanisms underlying stress-induced bone loss remain unclear. Here we demonstrate that neuropeptide Y (NPY), centrally and peripherally, plays a critical role in protecting against stress-induced bone loss. Mice lacking the anxiolytic factor NPY exhibit more anxious behavior and elevated corticosterone levels. Additionally, following a 6-week restraint, or cold-stress protocol, Npy-null mice exhibit three-fold greater bone loss compared to wild-type mice, owing to suppression of osteoblast activity. This stress-protective NPY pathway acts specifically through Y2 receptors. Centrally, Y2 receptors suppress corticotropin-releasing factor expression and inhibit activation of noradrenergic neurons in the paraventricular nucleus. In the periphery, they act to control noradrenaline release from sympathetic neurons. Specific deletion of arcuate Y2 receptors recapitulates the Npy-null stress response, coincident with elevated serum noradrenaline. Importantly, specific reintroduction of NPY solely in noradrenergic neurons of otherwise Npy-null mice blocks the increase in circulating noradrenaline and the stress-induced bone loss. Thus, NPY protects against excessive stress-induced bone loss, through Y2 receptor-mediated modulation of central and peripheral noradrenergic neurons.
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Affiliation(s)
- P A Baldock
- Neurological Disease Division, Garvan Institute of Medical Research, St Vincent's Hospital, Sydney, Australia; Osteoporosis and Bone Biology Division, Garvan Institute of Medical Research, St Vincent's Hospital, Sydney, Australia; Faculty of Medicine, University of New South Wales, Sydney, Australia
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Diem SJ, Joffe H, Larson JC, Tsai JN, Guthrie KA, LaCroix AZ, Ensrud KE, Freeman EW, Leder BZ. Effects of escitalopram on markers of bone turnover: a randomized clinical trial. J Clin Endocrinol Metab 2014; 99:E1732-7. [PMID: 25014001 PMCID: PMC4154080 DOI: 10.1210/jc.2014-2288] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
CONTEXT Recent observational studies have suggested that the use of selective serotonin reuptake inhibitors is associated with an increased fracture risk and an accelerated bone loss, although conflicting results have been reported. Furthermore, because many of these studies have been performed in depressed women, confounding by indication may influence these findings. OBJECTIVE The objective of the study was to determine whether selective serotonin reuptake inhibitors affect bone metabolism Design: This was a randomized controlled trial. SETTING The study was conducted in four US clinical sites. PARTICIPANTS Healthy peri- and postmenopausal women participated in the study. INTERVENTION The intervention was escitalopram (10-20 mg/d) for the treatment of vasomotor symptoms. MAIN OUTCOME MEASURES Serum carboxyterminal collagen crosslinks (CTX) and serum amino-terminal propeptide of type I collagen (P1NP) were measured. RESULTS One hundred forty-one peri- or postmenopausal nondepressed women (mean age 53.7 y, SD 4.1) had baseline and 8-week follow-up samples available for analysis and were included in the study (69 escitalopram, 72 placebo). The groups were balanced across a broad range of baseline characteristics, including age, race, body mass index, smoking status, and mood symptoms. The between-group differences in the change in CTX and P1NP from baseline to week 8 were compared by a repeated-measures linear regression model adjusted for race, clinical center, and baseline measurement. Treatment with escitalopram reduced serum P1NP by 1.02 ng/mL on average [95% confidence interval (CI) -5.17, 3.12] compared with a reduction of 1.88 ng/mL (95% CI -4.82, 1.06) in the placebo group (P = .65). Similarly, serum CTX decreased 0.02 ng/mL on average (95% CI -0.05, 0.01) in the escitalopram group compared with 0.00 ng/mL (95% CI -0.02, 0.02) in the placebo group (P = .24). The results were similar when the analysis was restricted to those women whose adherence to study medication was 70% or greater. CONCLUSIONS Although the study was limited to 8 weeks, these results suggest that escitalopram does not significantly alter bone metabolism in the short term.
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Affiliation(s)
- Susan J Diem
- University of Minnesota (S.J.D., K.E.E.), Minneapolis, Minnesota 55415; Brigham and Women's Hospital and Dana Farber Cancer Institute (H.J.), Boston, Massachusetts 02115; Fred Hutchinson Cancer Research Center (J.C.L., A.Z.L.), Seattle, Washington 98109; Massachusetts General Hospital (J.N.T., B.Z.L.), Boston, Massachusetts 02114; Minneapolis Veterans Affairs Health Care System (K.E.E.), Minneapolis, Minnesota 55417; and Perelman School of Medicine (E.W.F.), University of Pennsylvania, Philadelphia, Pennsylvania 19104
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Depressive symptoms are not associated with forearm bone accrual during adolescence. Arch Osteoporos 2014; 9:173. [PMID: 24619250 DOI: 10.1007/s11657-014-0173-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2013] [Accepted: 01/29/2014] [Indexed: 02/03/2023]
Abstract
UNLABELLED Although depression has been associated to worst bone physical properties in adulthood, this study showed that depressive symptoms were not significantly associated to bone mineral density measured at the forearm during adolescence. PURPOSE Depressive conditions have been related to the reduction of bone mineral density (BMD) in adulthood. Though it is possible to hypothesize that depressive symptoms present similar effects in bone mineral accrual during adolescence, such association is poorly researched. Therefore, we aimed to study the relation between depressive symptoms and forearm BMD during adolescence. METHODS The study is based on the Epidemiological Health Investigation of Teenagers cohort that sampled adolescents born in 1990 and enrolled in public and private schools of Porto during the 2003/2004 academic year. At baseline (n = 2,160) and at 17 years of age (n = 1,716), depressive symptoms were evaluated using the Beck Depression Inventory-II (BDI-II). BMD (grams per square centimetre) was measured at the non-dominant forearm using dual-energy X-ray absorptiometry. Sex-specific crude and adjusted linear regression coefficients (β) and the corresponding 95 % confidence intervals (95 % CIs) were calculated to estimate the cross-sectional and prospective associations between depressive symptoms and forearm BMD. RESULTS In both sexes, in early and late adolescence, depressive symptoms presented no statistically significant association with forearm BMD (β Girls13 = 0.09, 95 % CI = -0.43 to 0.61; β Girls17 = 0.10, 95 % CI = -0.43 to 0.64; β Boys13 = -0.10, 95 % CI = -0.96 to 0.76; β Boys17 = 0.49, 95 % CI = -0.96 to 1.93). Similarly, there were no significant associations between depressive symptoms and the annual forearm BMD change during adolescence in girls and boys (β Girls_BDI-II_13-17_remained_lowest = -0.85, 95 % CI = -4.62 to 2.92 vs. β Girls_BDI-II_13-17_remained_highest = -1.87, 95 % CI = -5.06 to 1.31; β Boys_BDI-II_13-17_remained_lowest = 0.48, 95 % CI = -5.30 to 6.26 vs. β Boys_BDI-II_13-17_remained_highest = 1.36, 95 % CI = -3.25 to 5.97). CONCLUSIONS Depressive symptoms, with the range of severity observed in the general adolescent population, were not associated with changes in forearm bone mineral density during adolescence. Further research based on measurements of different skeletal sites is needed in order to detect a systemic effect of depression on growing bone.
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Diem SJ, Ruppert K, Cauley JA, Lian Y, Bromberger JT, Finkelstein JS, Greendale GA, Solomon DH. Rates of bone loss among women initiating antidepressant medication use in midlife. J Clin Endocrinol Metab 2013; 98:4355-63. [PMID: 24001746 PMCID: PMC3816266 DOI: 10.1210/jc.2013-1971] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
CONTEXT Concern has been raised that medications that block serotonin reuptake may affect bone metabolism, resulting in bone loss. OBJECTIVE The aim of the study was to compare annual bone mineral density (BMD) changes among new users of selective serotonin reuptake inhibitors (SSRIs), new users of tricyclic antidepressants (TCAs), and nonusers of antidepressant medications. DESIGN AND SETTING We conducted a prospective cohort study at five clinical centers in the United States. PARTICIPANTS The study included 1972 community-dwelling women, aged 42 years and older, enrolled in the Study of Women's Health Across the Nation (SWAN). EXPOSURE The use of antidepressant medications was assessed by interview and verified from medication containers at annual visits. Subjects were categorized as nonusers (no SSRI or TCA use at any examination), SSRI users (initiated SSRI use after the baseline SWAN visit), or TCA users (initiated TCA use after the baseline visit), using a computerized dictionary to categorize type of medication. MAIN OUTCOME MEASURES BMD at the lumbar spine, total hip, and femoral neck was measured using dual-energy x-ray absorptiometry at annual visits. RESULTS BMD was compared among 311 new users of SSRIs, 71 new users of TCAs, and 1590 nonusers. After adjustment for potential confounders, including age, race, body mass index, menopausal status, and hormone therapy use, mean lumbar spine BMD decreased on average 0.68% per year in nonusers, 0.63% per year in SSRI users (P = .37 for comparison to nonusers), and 0.40% per year in TCA users (P = .16 for comparison to nonusers). At the total hip and femoral neck, there was also no evidence that SSRI or TCA users had an increased rate of bone loss compared with nonusers. Results were similar in subgroups of women stratified by the Center for Epidemiologic Studies Depression Scale (<16 vs ≥16). CONCLUSIONS In this cohort of middle-aged women, use of SSRIs and TCAs was not associated with an increased rate of bone loss at the spine, total hip, or femoral neck.
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Affiliation(s)
- Susan J Diem
- MD, MPH, 1100 Washington Avenue South, Suite 201, Minneapolis, Minnesota 55415.
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Carbone LD, Chin AS, Burns SP, Svircev JN, Hoenig H, Heggeness M, Weaver F. Morbidity following lower extremity fractures in men with spinal cord injury. Osteoporos Int 2013; 24:2261-7. [PMID: 23392311 DOI: 10.1007/s00198-013-2295-8] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2012] [Accepted: 01/03/2013] [Indexed: 11/29/2022]
Abstract
UNLABELLED The Veterans Affairs Spinal Cord Dysfunction Registry from 2002 to 2007 was reviewed to determine whether men with spinal cord injury (SCI) and lower extremity fractures had an increased risk of complications compared to those without fractures. We determined that fractures are associated with significant consequences, particularly during the first month postfracture. INTRODUCTION Despite increasing longevity, patients with SCI have a substantial number of illnesses and comorbid conditions. Lower extremity fractures are frequent events in these patients. However, whether these fractures are associated with any increased risk of complications in SCI is not certain. The purpose of this report was to determine the impact of lower extremity fractures on morbidities in men with SCI. METHODS A population-based, nested, case-control (1,027 cases and 1,027 propensity-matched controls) of men enrolled in the Veterans Affairs Spinal Cord Dysfunction Registry from fiscal years 2002 to 2007 was reviewed to determine whether lower extremity fractures were associated with an increased risk for complications. RESULTS In propensity score models matched for demographic (age, race) and SCI-related injury factors (level/completeness of SCI), Veterans Affairs-service connection status, and comorbidities, at 1 month following the fracture, there was an increased risk for respiratory infections, pressure ulcers, urinary tract infections, thromboembolic events, depression, and delirium (p ≤ 0.03 for all). Over 12 months, the only complication more common in fracture cases was pressure ulcers (p < 0.01), with an absolute difference of less than 2 % when compared to controls. There was no significant increased risk of cardiac arrhythmias at any time examined following fracture (≥0.12). CONCLUSIONS Lower extremity fractures are associated with significant consequences in men with SCI during the first month postfracture, but they do not persist for a long term, except for pressure ulcers. Targeted interventions to prevent complications should be considered following lower extremity fractures in SCI, particularly in the first month following fracture.
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Affiliation(s)
- L D Carbone
- Veterans Affairs Medical Center, Memphis, TN 38163, USA.
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Oh SM, Kim HC, Kim KM, Ahn SV, Choi DP, Suh I. Association between depressive symptoms and bone stiffness index in young adults: the Kangwha study. PLoS One 2013; 8:e69929. [PMID: 23894562 PMCID: PMC3722098 DOI: 10.1371/journal.pone.0069929] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2013] [Accepted: 06/13/2013] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVE Young adulthood is an important period for both bone and mental health. This study investigated the association between depressive symptoms and bone density in apparently healthy Korean men and women aged 29-32 years. METHODS This study is a cross-sectional analysis of data from 123 men and 133 women who completed follow-up examinations of the Kangwha study in 2010-2011. Bone stiffness index (SI) was measured at the os calcis using a quantitative ultrasound device. Depressive symptoms were evaluated using the Korean version of the Beck Depression Inventory (K-BDI) and classified as normal (K-BDI <10), mild (K-BDI 10-15), and moderate to severe (K-BDI ≥16). RESULTS Moderate to severe depressive symptoms were prevalent among 11.4% of men and 19.6% of women. Higher K-BDI scores were significantly correlated to SI in men, before (ρ = -0.286, p = 0.001) and after (ρ = -0.228, p = 0.013) adjustment for covariates. Men with depressive symptoms tended to have a lower SI; multivariate-adjusted mean SI in men with normal, mild, and moderate to severe depressive symptoms was 104.1±3.1, 100.9±5.9, and 94.1±7.8, respectively (p for trend = 0.021). In contrast, no significant correlations were identified in women. CONCLUSIONS Depressive symptoms were significantly associated with lower SI in men, but not in women. Further studies are necessary to evaluate the impact of depression on developing osteoporosis or osteoporotic fractures later in life.
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Affiliation(s)
- Sun Min Oh
- Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Hyeon Chang Kim
- Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Kyoung Min Kim
- Department of Internal Medicine, Institute of Endocrine Research, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Song Vogue Ahn
- Department of Preventive Medicine, Wonju College of Medicine, Yonsei University, Wonju, Republic of Korea
| | - Dong Phil Choi
- Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Il Suh
- Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
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Aloumanis K, Mavroudis K. The "depressive" face of osteoporosis and the "osteoporotic" face of depression. Hormones (Athens) 2013; 12:350-62. [PMID: 24121377 DOI: 10.1007/bf03401301] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Osteoporosis and depression are two chronic diseases that affect large population groups with great impact on morbidity, mortality and quality of life. An association between osteoporosis and depression has been described in the literature. Definitely, limited data suggest that osteoporosis may enhance depressive symptoms, while far more studies have shown that depression adversely affects bone density and increases fracture risk. However, neither causation nor a firm pathophysiological connection has been established. Thus the correlation of these diseases is still under research. This review comments on a plausible causative relationship and underlying mechanisms that might elucidate the link between two very common diseases. We describe the possible impact of osteoporosis on moods and the (better established) effect of depression on bone health. We also describe the effect of medication and review hormonal and cellular signals that may explain this effect.
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