Increased risk of osteoporosis in patients with depression: a population-based retrospective cohort study

Differential expression of plasma extracellular vesicles microRNAs and exploration of their association with bone metabolism in childhood trauma participants treated in a psychosomatic clinic

Introduction

Early life stress (ELS) impacts neurotransmitters and cell communication, potentially disrupting neurological and physiological processes. Recently, ELS has been implicated in impaired bone metabolism, with extracellular vesicles (EVs) and their cargo, microRNAs (miRNAs), might affecting this process. This research aimed to elucidate the association between childhood trauma, a specific form of ELS, and bone metabolism through studying miRNA in EVs within three steps: firstly, examining alterations of EV miRNAs between ELS and controls, secondly analyzing associations between altered EV miRNAs and bone markers, and thirdly exploring the target gene prediction and enrichment pathways of altered EV miRNAs.

Methods

This study included a subgroup of the DEPREHA project (total n=208) from a psychosomatic clinic. Firstly, real-time quantitative PCR was performed on plasma EVs isolated from childhood trauma participants with depression (n=6) and matched healthy controls (n=9) to detect the differentially expressed EV miRNAs. Secondly, general linear regression models were employed to investigate the associations between specific EV miRNAs and circulating bone turnover markers (procollagen type 1 amino-terminal propeptide (P1NP), osteocalcin, and β-CrossLaps (CTx)), adjusting for depression as a potential confounder. Thirdly, the miRNA target gene networks and enriched pathways were explored based on altered EV miRNAs.

Results

These analyses could be conducted on n=19 participants from the entire group (11 [57.9%] female; median [IQR] age, 35.00 [26.00] years), but finally n=15 participants were included for analyses. 22 out 380 EV miRNAs were differentially expressed between childhood trauma participants (6 up-regulated and 16 down-regulated) and healthy controls. Among these, miR-25-3p, miR-26b-5p, miR-451a, and miR-421 were associated with P1NP (bone formation marker) and CTx (bone resorption marker). MiR-26b-5p, miR-330-3p, and miR-542-5p were associated with osteocalcin (bone turnover marker). MiRNA target gene network prediction revealed highly associated target genes of dysregulated miRNAs, such as Trinucleotide Repeat Containing Adaptor 6B (TNRC6B), and enrichment analysis highlighted pathways including the forkhead box protein O (FoxO) signaling pathway.

Discussions

This study explored the potential associations between childhood trauma and bone metabolism, due to the sample size and experimental group limitations, these associations should be validated in future experiments with larger sample sizes and different control group settings.

The Impact of Depression on Detrimental Changes in Bone Microstructure in Female Mice

Background

Several clinical studies have examined the connection between depression and bone loss, but the cause-and-effect relationship between the two conditions, especially in animal models, is not well-studied.

Methods

A total of 32 female mice were, randomly divided into control group (CON, n=19) and depression group (DEP, n=13). The mice in the DEP group were subjected to 21 consecutive days of restraint stress, following depressive-like behaviors were assessment. The femurs were collected using Micro-Computed Tomography (μCT) and histochemical staining. In parallel, levels of serotonin-related proteins in the brain were measured using Western blot analysis, and sex hormone profiles were determined through liquid chromatography-mass spectrometry/mass spectrometry (LC-MS/MS).

Results

The mice in the DEP group exhibited clear signs of depressive-like behaviors and an increase in serotonin transporter levels (t=-2.435, P< 0.05). In comparison to the CON mice, the DEP mice showed a decrease in bone mineral density (t =3.741, P< 0.05), bone surface area density (t =8.009, P<0.01), percent bone volume (t =4.293, P< 0.05), trabecular number (t =5.844, P<0.01), and connected density (t =11.000, P< 0.05). Additionally, there was an increase in trabecular separation (t =-7.436, P<0.01) in DEP mice. Furthermore, the DEP mice displayed a significant reduction in serum estrogen levels (t =4.340, P< 0.05) and changes in its metabolite (t =-3.325, P< 0.05), while the levels of androgens remained unchanged.

Conclusion

The restraint stress not only led to the development of depressive-like behaviors but also disrupted the estrogen metabolism pathway, resulting in damage to bone mass and microstructure in female mice. These findings suggest that stress-induced depression may pose a risk for bone loss in female mice by altering estrogen metabolism pathways.

Plasma exosomal miR-30a-5p inhibits osteogenic differentiation of bone marrow mesenchymal stem cells from a chronic unpredictable mild stress-induced depression rat model

With rising society stress, depression-induced osteoporosis is increasing. However, the mechanism involved is unclear. In this study, we explored the effect of plasma exosomal miRNAs on bone marrow mesenchymal stem cell (BMSC) osteogenic differentiation in a chronic unpredictable mild stress (CUMS)-induced depression rat model. After 12 weeks of CUMS-induced depression, the pathological changes in the bone tissue and markers of osteogenic differentiation were tested by micro-computed tomography, hematoxylin-eosin staining, and quantitative real-time reverse transcription PCR (qRT-PCR). Plasma exosomes from rats were isolated and co-incubated with BMSCs for 14 d to detect the effect on osteogenic markers. Next-generation sequencing identified the miRNAs in the plasma exosomes, and the differential miRNAs were analyzed and verified by qRT-PCR. BMSCs were infected with lentivirus to upregulate miRNA-30a-5p and incubated in a medium that induced osteogenic differentiation for 14 d. The effect of miR-30a-5p on osteogenic differentiation was determined by qPCR and alizarin red staining. CUMS-induced depression rat model was established successfully, and exhibited reduced bone mass and damaged bone microstructure compared to that of the controls. The observed pathological changes suggested the occurrence of osteoporosis in the CUMS group, and the mRNA expression of osteogenic markers was also significantly reduced. Incubation of BMSCs with plasma exosomes from the CUMS group for 14 d resulted in a significant decrease in the expression of osteogenic markers. Twenty-five differentially expressed miRNAs in plasma exosomes were identified and upregulation of miR-30a-5p was observed to significantly inhibit the expression of osteogenic markers in BMSCs. Our findings contributed to a comprehensive understanding of the mechanism of osteoporosis caused by depression, and demonstrated the potential of miR-30a-5p as a novel biomarker or therapeutic target for the treatment of osteoporosis.

Delayed Scaphoid Fracture Union in Patients With Comorbid Psychiatric Diagnoses: A Retrospective Analysis of 20 340 Patients

BACKGROUND

Psychiatric comorbidities have been shown to influence outcomes of various orthopedic pathologies. This study aimed to compare rates of delayed scaphoid union and surgical intervention for fractures in patients with and without comorbid psychiatric diagnoses.

METHODS

A matched retrospective cohort study was performed using the PearlDiver database to determine the association of depression, anxiety, bipolar disorder, and schizophrenia with delayed union rates within 3 and 6 months and rates of nonacute surgical intervention (fixation or grafting) within 6 and 12 months of scaphoid fracture. Analyses were completed using multivariate logistic regression.

RESULTS

Among 20 340 patients, a comorbid psychiatric diagnosis was associated with increased rates of delayed scaphoid union at 3 months (odds ratio [OR] = 1.29; 95% confidence interval [CI], 1.14-1.45) and 6 months (OR = 1.23; 95% CI, 1.10-1.38). At 3 months, women with any psychiatric disorder (OR = 1.58; 1.29-1.66), depression (OR = 1.68; 1.31-2.17), and schizophrenia (OR = 5.32; 95% CI, 1.06-26.79) were more likely to experience delayed union, with similar results at 6 months. Men with bipolar disorder experienced increased delayed union rates at 6 months (OR = 1.40; 1.03-1.91). A comorbid psychiatric diagnosis (OR = 1.10; 1.01-1.20) was associated with increased rates of surgical intervention, whereas schizophrenia was associated with decreased rates (OR = 0.58; 0.34-0.99).

CONCLUSION

Patients with comorbid psychiatric conditions experienced increased rates of delayed scaphoid union. These results underscore the importance of understanding factors that may place patients at risk of impaired recovery.

Link between depression and bone mineral density in Cooper Center Longitudinal Study: Indirect effects of vitamin D, inflammation, and physical activity

BACKGROUND

To examine the effect of depressive symptom severity on bone mineral density (BMD) and the potential mediators of the relationship.

METHOD

This study used data from n = 7273 participants in the Cooper Center Longitudinal Study at the Cooper Clinic in Dallas. Participants were included if they had data for all study variables, including left and right femoral neck (BMD), age, sex, body mass index, smoking status, antidepressant (SSRI/SNRI) use, standard alcoholic drinks consumed per week, and depressive symptom severity as measured with the Center for Epidemiological Studies-Depression (CESD)-10. To evaluate the effect of depressive symptoms on both L/R femur BMD, two multiple linear regression analyses were conducted. To examine effects of vitamin D, high sensitivity C-reactive protein (hs-CRP), and physical activity (MET units) on the relationship between depressive symptom severity and BMD, parallel mediation analyses were conducted.

RESULTS

Depressive symptom severity (CES-D 10 score) significantly predicted both L/R BMD (L: β = -0.048, R: β = -0.047, both p ≤ .001). Only physical activity significantly mediated the relationship between depressive symptom severity and L/R BMD (L: β = -0.008, 95 % CI [-0.011, -0.005]; R: β = -0.007, 95 % CI [-0.010, -0.005]).

LIMITATIONS

The sample may not be generalizable to all patient populations.

CONCLUSION

Depressive symptom severity was inversely related to both L/R femur BMD in a large cohort of relatively healthy adults. Physical activity, but not vitamin D or hs-CRP, mediated this relationship. Future research might examine the effect of physical activity interventions both on depression and BMD.

IMPACT STATEMENT

We certify that this work is both novel and confirmatory of recent clinical research (Lee et al., 2015; Amsterdam and Hooper, 1998; Hlis et al., 2018; Wainstein et al., 2016; Blair et al., 1989; Farrell et al., 2022; Ainsworth et al., 2011). We demonstrated a negative relationship between depression and BMD in a large cohort of adults and expanded on previous findings by demonstrating that physical activity acts as a mediator of this relationship. Physical activity is known to stimulate osteogenesis in osteoporotic patients, and this study further expands on its role in depressive symptoms in this population.

KEY POINTS

Duration of the untreated period affects bone mineral density in psychiatric patients requiring long-term hospitalization: A cross-sectional study

Aim

Osteoporosis and bone fractures occur often on psychiatric wards. Although recent studies showed that bone mineral density (BMD) decreases in psychiatric patients, many risk factors remain unknown. This study aimed to explore the risk factors for decreased BMD in long-term psychiatric inpatients in a closed ward.

Methods

A cross-sectional study of psychiatric inpatients hospitalized for over 20 weeks was conducted. Patients were divided into three groups according to BMD: normal, osteopenia, and osteoporosis. Psychiatric symptoms were assessed using the Brief Psychiatric Rating Scale (BPRS). The relevant history of psychiatric diseases was collected, and biomarkers related to osteoporosis were measured. Univariable and multivariable ordinal logistic regression analyses were performed to identify variables significantly associated with BMD category. Additional analyses evaluated the associations between an identified clinical variable and biomarkers and psychiatric symptoms that may be related to osteoporosis.

Results

Seventy-one patients (28 normal BMD, 17 osteopenia, and 26 osteoporosis) participated in the study. The multivariable ordinal logistic analysis showed that the duration of untreated psychosis (DUP) was a risk factor (odds ratio = 0.77, 95% confidence interval: 0.63-0.91, p = 0.006), adjusting for the major confounders of sex and age. Additional analysis showed significant differences in BPRS, BPRS Negative Symptom score, and the Cu/Zn ratio between the short-DUP group (DUP ≤ 1 year) and the long-DUP group (DUP > 1 year).

Conclusion

The DUP may affect BMD in long-term psychiatric inpatients, presumably partly through increased severity of negative symptoms and micronutrient abnormalities. Shortening the untreated period might reduce the risk of osteoporosis.

Association between bipolar affective disorder, use of antidepressants and osteoporosis

Introduction/Objective. Osteoporosis is one of the most common comorbid disorders in depressive mood disorder. The aim of this study was to assess the association between the use of antidepressants and osteoporosis in patients with bipolar affective disorder (BPAD). Methods. The study included 73 inpatients, aged 50?72 years, male and female, hospitalized with a depressive episode of BPAD from 2016 to 2020 at the Clinic of Psychiatry, Clinical Centre of Vojvodina, divided into two groups: a) the first group (40) was treated with selective serotonin reuptake inhibitors (SSRIs) in combination with mood stabilizer (lithium carbonate/lamotrigine); b) the second group (33) was treated with mood stabilizer only. Study included two control groups as well. Clinical measurements of bone mineral density at lumbar spine and hip was made using dual energy X-ray absorptiometry. CrossLaps and levels of calcium and vitamin D were collected from blood samples. The data was analyzed by the analysis of variance and the Kruskal?Wallis test. Results. Osteoporosis was registered in 25% of patients in the first group and in 18% of patients in the second group, while osteopenia was observed within 40% of patients in the first group and in 37% of patients in the second group. There was significant difference in value of CrossLaps, and the level of 25(OH)D vitamin between the control groups and the first two groups, as well as in prevalence of osteoporosis and osteopenia. Conclusion. Depressive episodes in BPAD is connected with higher prevalence of osteoporosis. Patients treated with SSRIs have higher prevalence of osteoporosis than patients treated with mood stabilizers only.

Incidence of osteoporosis and ambient air pollution in South Korea: a population-based retrospective cohort study

Background

This study investigated the associations between exposure to ambient air pollutants and the incidence of osteoporosis using the Korean National Insurance Service–National Sample Cohort.

Methods

This nationwide, population-based, retrospective cohort study included 237,149 adults aged ≥40 years that did not have a diagnosis of osteoporosis at baseline between January 1, 2003, and December 31, 2015. Osteoporosis was defined as claim codes and prescriptions of bisphosphonates or selective estrogen receptor modulators at least twice annually. After matching values for PM₁₀, NO₂, CO, and SO₂ during the 2002–2015 time period and PM_2.5 in 2015 with residential areas, the incidence of osteoporosis was analyzed using a Cox proportional hazards regression model according to the quartile of average yearly concentrations of pollutants.

Results

Overall 22.2% of the study subjects, 52,601 (male: 5.6%, female: 37.6%) adults in total, were newly diagnosed with osteoporosis and treated. Exposure to PM₁₀ was positively associated with incidence of osteoporosis (Q4: 1798 per 100,000 person-years vs. Q1: 1655 per 100,000 person-years). The adjusted hazard ratio (HR) with 95% confidence interval (CI) of Q4 in PM₁₀ was 1.034 (1.009–1.062). The effect of PM₁₀ on osteoporosis incidence was distinct in females (adjusted sub-HR: 1.065, 95% CI: 1.003–1.129), subjects aged < 65 years (adjusted sub-HR: 1.040, 95% CI: 1.010–1.072), and for residents in areas with low urbanization (adjusted sub-HR: 1.052, 95% CI: 1.019–1.087). However, there was no increase in osteoporosis based on exposure to NO₂, CO, SO₂, or PM_2.5.

Conclusions

Long-term exposure to PM₁₀ was associated with newly diagnosed osteoporosis in Korean adults aged ≥40 years. This finding can aid in policy-making that is directed to control air pollution as a risk factor for bone health.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-021-11866-7.

Risk of osteoporosis in patients with erectile dysfunction: A PRISMA-compliant systematic review and meta-analysis

BACKGROUND

Erectile dysfunction (ED) and osteoporosis are both common health problems and have similar risk factors. Recent studies have found that people with ED have a higher risk of osteoporosis.We aimed to systematically assess osteoporosis risk in patients with ED.

METHODS

A systematically research was carried out in Medline via PubMed, Cochrane Library, EMBASE, and Web of Science up to June 4, 2020, to identify articles related to ED and osteoporosis. The 2 researchers independently reviewed the literature, extracted the data, and evaluated the quality of the literature. All analyses were done using RevMan5.3 and Stata14.

RESULTS

A total of 4 studies involving 22,312 participants were included. The meta-analysis results showed that the risk of osteoporosis in the ED group was significantly higher than that in the non-ED group [odds ratio (OR) = 2.66, 95% confidence interval (95% CI) 1.42 to 4.98, P = .002, I2 = 68%]. Interestingly, compared with older participants, the increased risk of osteoporosis in ED patients seemed to be more pronounced in younger participants. Despite the lack of data for meta-analysis, more than half of the literature mentioned this tendency. We found the source of heterogeneity through sensitivity analysis, and there was no significant effect on the results before and after the removal of this literature, indicating that our results were robust. No obvious publication bias was found through Egger method (P = .672).

CONCLUSION

People with ED have a higher risk of osteoporosis, especially among younger males. Because the assessment of osteoporosis is economical and noninvasive, ED patients should be evaluated by bone mineral density or men with osteoporosis should be further assessed for erectile function.

Post-surgery cholecystectomy, hepatectomy, and pancreatectomy patients increase the risk of osteoporotic vertebral fracture

INTRODUCTION

Data is currently lacking regarding association between the cholecystectomy/hepatectomy/pancreatectomy and the development of osteoporotic fracture. A retrospective cohort study was conducted to investigate the relationship between cholecystectomy/hepatectomy/pancreatectomy and the subsequent risk of developing osteoporotic fracture.

MATERIALS AND METHODS

Patients having undergone cholecystectomy, hepatectomy, or pancreatectomy between 2000 and 2012 were selected from the All Population Based Hospitalization File as the surgery cohort (n = 304,081), which was frequency matched with the control cohort (n = 304,081). The Cox proportional hazard model and Kaplan-Meier analysis were applied to measure the hazard ratios and the cumulative incidence of osteoporotic fracture.

RESULTS

A total of 1136 patients in the surgery cohort and 1179 patients in the control cohort were newly diagnosed with osteoporotic fracture. The overall osteoporotic fracture risk in the surgery cohort was 1.12-fold higher [95% confidence interval (CI), 1.03-1.21]. Specifically, surgery cohort had higher vertebral fracture risk than non-surgery cohort [adjusted hazard ratio (aHR) 1.12, Cl, 1.03-1.22]. In addition, patients underwent cholecystectomy (includes open and laparoscopic approaches), hepatectomy (only open approach), and pancreatectomy group (only open approach) were 1.10 (95% CI, 1.01-1.19), 1.49 (95% CI, 1.10-2.01), and 1.88 (95% CI, 1.23-2.87) times more likely to develop osteoporotic fracture, respectively. No significant difference of osteoporotic fracture risk was observed between open and laparoscopic cholecystectomy. The risk of osteoporotic fracture was significantly increased in females, patients aged ≥ 40 years old, and patients with some comorbidity.

CONCLUSIONS

Patients post cholecystectomy, hepatectomy, or pancreatectomy significantly increased risk of developing osteoporotic fracture, suggesting closer attention in post-operative care is needed.

Effects of Neurological Disorders on Bone Health

Neurological diseases, particularly in the context of aging, have serious impacts on quality of life and can negatively affect bone health. The brain-bone axis is critically important for skeletal metabolism, sensory innervation, and endocrine cross-talk between these organs. This review discusses current evidence for the cellular and molecular mechanisms by which various neurological disease categories, including autoimmune, developmental, dementia-related, movement, neuromuscular, stroke, trauma, and psychological, impart changes in bone homeostasis and mass, as well as fracture risk. Likewise, how bone may affect neurological function is discussed. Gaining a better understanding of brain-bone interactions, particularly in patients with underlying neurological disorders, may lead to development of novel therapies and discovery of shared risk factors, as well as highlight the need for broad, whole-health clinical approaches toward treatment.

Bone Metabolism in Patients Treated for Depression

BACKGROUND

Depression and osteoporosis are severe public health problems. There are conflicting findings regarding the influence of depression on bone metabolism. The aim of the presented study was to compare bone turnover markers and vitamin D levels between patients treated for depression and healthy controls.

PATIENTS AND METHODS

We determined a concentration of osteocalcin, carboxy-terminal telopeptide of type I collagen (β-CTX), 25-hydroxyvitamin D (25OHD) and 1,25(OH)₂D₃ in 99 patients, aged 46.9 ± 11 years, treated for depression, as well as in 45 healthy subjects. Depressive status was determined with the Hamilton Depression Scale (HDRS).

RESULTS

In patients treated for depression, we demonstrated significantly lower osteocalcin concentrations (p < 0.03) and higher concentration of β-CTX (result on the border of significance; p = 0.08). Those relationship were stronger in women. The level of 25OHD and 1,25(OH)₂D₃ did not differ significantly between the examined groups. We observed a negative correlation between the 25OHD and HDRS score after treatment in all patients treated for depression and in subgroups of women and subjects with recurrent depression.

CONCLUSIONS

Our results indicate that depression is related to disturbances in bone metabolism, especially in women and patients with recurrent depression, suggesting its role in context of osteoporosis development.

Mood Disorders are Associated With Increased Risk of BPPV: A National Sample Cohort

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.

Major depressive disorder is associated with subsequent adult-onset asthma: a population-based cohort study

AIM

To examine the incidence of asthma in adult patients with major depressive disorder (MDD).

METHODS

From the National Health Insurance database of Taiwan, we identified 30 169 adult patients who were newly diagnosed with MDD between 2000 and 2010. Individuals without depression were randomly selected four times and frequency matched for sex, age and year of diagnosis. Both cohorts were followed-up for the occurrence of asthma up to the end of 2011. Adjusted hazard ratios (aHRs) of asthma were estimated using the Cox proportional hazards method.

RESULTS

The overall incidence of asthma was 1.91-fold higher in the MDD cohort than in the non-depression cohort (7.55 v. 3.96 per 1000 person-years), with an aHR of 1.66 (95% confidence interval (CI) 1.55-1.78). In both cohorts, the incidence of asthma was higher in patients and controls who were female, aged, with comorbidities and users of aspirin or beta-adrenergic receptor blockers. No significant difference was observed in the occurrence of asthma between patients with MDD treated with selective serotonin reuptake inhibitors (SSRIs) and those treated with non-SSRIs (SSRIs to non-SSRIs aHR = 1.03, 95% CI 0.91-1.17).

CONCLUSION

Adult patients with MDD are at a higher risk of asthma than those without depression are.

Association between mental health status and bone mineral density: Analysis of the 2008-2010 Korea national health and nutrition examination survey

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.

Association of the serotonin transporter-linked polymorphic region genotype with lower bone mineral density

The serotonin transporter-linked polymorphic region (5-HTTLPR) of the serotonin transporter gene (SLC6A4) S allele is linked to pathogenesis of depression and slower response to selective serotonin reuptake inhibitors (SSRIs); depression and SSRIs are independently associated with bone loss. We aimed to determine whether 5-HTTLPR was associated with bone loss. This cross-sectional study included psychiatric patients with both 5-HTTLPR analysis and bone mineral density (BMD) assessment (hip and spine Z-scores if age <50 years and T-scores if ⩾50 years). BMD association with 5-HTTLPR was evaluated under models with additive allele effects and dominant S allele effects using linear regression models. Patients were stratified by age (<50 and ⩾50 years) and sex. Of 3016 patients with 5-HTTLPR genotyping, 239 had BMD assessments. Among the younger patients, the S allele was associated with lower Z-scores at the hip (P=0.002, dominant S allele effects; P=0.004, additive allele effects) and spine (P=0.0006, dominant S allele effects; P=0.01, additive allele effects). In sex-stratified analyses, the association of the S allele with lower BMD in the younger patients was also significant in the subset of women (P⩽0.003 for both hip and spine BMD under the additive allele effect model). In the small group of men younger than 50 years, the S allele was marginally associated with higher spine BMD (P=0.05). BMD T-scores were not associated with 5-HTTLPR genotypes in patients 50 years or older. The 5-HTTLPR variants may modify serotonin effects on bone with sex-specific effects.

Effect of acute pancreatitis on the risk of developing osteoporosis: A nationwide cohort study

PURPOSE

Chronic exocrine pancreatic insufficiency can lead to osteoporosis. However, the incidence and risk of osteoporosis after acute inflammation of pancreas remained known. Thus, we conducted a population-based cohort study to clarify the association between acute pancreatitis (AP) and osteoporosis.

METHODS

Patients newly diagnosed with AP with index date between 2000 and 2011 were identified from the National Health Insurance Research Database. Osteoporosis were defined according to the International Classification of Diseases, Ninth Revision, Clinical Modification codes. We applied age-, sex-, and comorbidities-adjusted variable Cox proportional hazard models for assessing the association between AP and osteoporosis. Moreover, these models were used to adjust for the influences of patient characteristics and comorbidities.

RESULTS

In this study, 4,016 patients were included in the AP cohort (males, 67.9%; mean age, 51.8 years) and 4,016 matched controls in the non-AP cohort. After a mean follow-up period of 4.97 and 5.21 years in the AP and non-AP cohorts, respectively, the incidence of osteoporosis was 8.22 per 1000 person-years in the AP cohort. The AP cohort had a higher risk [adjusted hazard ratio (aHR) = 1.27, 95% confidence interval (CI) = 1.02-1.58] of osteoporosis than did the non-AP cohort. The risk of osteoporosis was highest in the female patients of the AP cohort (aHR = 2.26, 95% CI = 1.85-2.76) and patients aged 50-64 years (aHR = 4.14, 95% CI = 3.13-5.47).

CONCLUSION

AP patients are at a risk of osteoporosis, especially female gender and age 50-64 years. Those with > 3 episodes of AP had highest significant risk of developing osteoporosis.

Effects of depression and antidepressant medications on hip fracture: A population-based cohort study in Taiwan

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.

Increased risk of fracture in patients with bipolar disorder: a nationwide cohort study

OBJECTIVES

Bipolar disorder (BD) is a systemic inflammatory disease, and disrupted bone metabolism due to the inflammatory process can cause fracture. Despite evidence of an association between lower bone mineral density and an increased risk of fracture among patients with depression, schizophrenia, and anorexia nervosa, whether BD is a risk factor for subsequent fracture is unknown. To determine the association between BD and fracture and to examine the risk factors for fracture among patients with BD.

METHODS

In this study, we enrolled patients diagnosed with BD from the Taiwan National Health Insurance Research Database. Patients newly diagnosed with BD (ICD-9-CM 296) from 2001 to 2008 were included in the BD cohort, and the date of the initial diagnosis of BD was used as the index date. The comparison cohort, comprising participants without BD, was frequency matched to the BD cohort by age, sex, and index year, and the occurrence of fracture was evaluated in both cohorts.

RESULTS

The BD and comparison cohorts were comprised of 47,271 patients with BD and 1,89,084 frequency-matched participants without BD, respectively. The incidence of fracture was higher among patients with BD than among the controls. Cox models showed that BD was an independent risk factor for fracture irrespective of comorbidities [hazard ratio (HR) = 1.79, 95 % confidence interval (CI) = 1.73-1.84, p < .001].

CONCLUSION

Our study showed that patients with BD have a higher risk of subsequent fracture. Additional prospective clinical studies investigating the relationship between BD and fracture are warranted.

The incidence and risk of osteoporosis in patients with anxiety disorder: A Population-based retrospective cohort study

The purpose of this study was to investigate the relationship between anxiety disorder (AD) and the subsequent development of osteoporosis.We conducted a population-based retrospective cohort analysis according to the data in the Longitudinal Health Insurance Database 2000 of Taiwan. We included 7098 patients in both the AD and no-anxiety cohort who were matched according to age and sex between January 1, 2000, and December 31, 2013. The incidence rate and the risk ratios (RRs) of subsequent new-onset osteoporosis were calculated for both cohorts. We used Cox proportional hazards models to assess the effect of AD. The Kaplan-Meier method was applied to estimate the cumulative osteoporosis incidence curves.The AD cohort consisted of 7098 patients, and the comparison cohort comprised the same matched control patients without anxiety. The risk of osteoporosis was higher in the AD cohort than in the comparison cohort. In addition, the incidence of newly diagnosed osteoporosis remained significantly increased in all of the stratified follow-up durations (0-1, 1-5, 5-10, ≥10years). Patients with AD were 1.79 times more likely to get osteoporosis than those without AD. We also observed a significant increase in osteoporotic risk in AD patients who are comorbid with hypertension, diabetes mellitus, and chronic liver disease.The incidence of osteoporosis in Taiwan is associated with an a priori AD history. The risk ratios are the highest for osteoporosis within 1 year of AD diagnosis, but the risk remains statistically significant for >1 year. Clinicians should pay particular attention to osteoporotic comorbidities in AD patients.