Does Depression Cause Osteoporosis?

Patient Expert

Does having osteoporosis depress you?

Or does depression lead you into osteoporosis?

That's been a question researchers have been trying to answer for the past 15 years or more. Since the early 1990s, scientists have been studying links among depression, low bone mass, and fractures, particularly in women.

Back in 1996, The New England Journal of Medicine reported that women with depression exhibit bone mass up to 15% lower than the general population.

But is this lower bone mass caused by depression?

Or are the patients in the study depressed because of their struggles living with osteoporosis: its pain, its difficult treatment, the diminution of an active lifestyle?

Ah, the old chicken-and-egg question. Now, thanks to a newly developed statistical tool - meta-analysis - it appears we may have an answer.

ScienceDaily online reported in November that researchers at Hebrew University in Jerusalem had compiled the results of every study ever conducted regarding the osteoporosis/depression link - 23 studies in 8 countries, to be precise. As part of the meta-analysis process, the information from all those studies was combined into a single database, covering tens of thousands of subjects, instead of just the small numbers involved in each individual study.

The result? Overwhelming evidence that clinical depression causes bone loss. Granted, some osteoporosis patients diagnosed with depression may cite their disease as a contributing factor; but in most cases, depression comes first, then bone loss. The Hebrew University study found this link particularly strong in young women.

What's happening here? The data shows that women diagnosed with clinical depression have an elevated level of osteoclasts, cells that break down bones. The more osteoclasts, the more out of balance the cycle of bone buildup and bone breakdown becomes, the greater the loss of bone density.

Professors Itai Bab and Raz Yirmiya, authors of the study, don't yet know the exact biochemical link between depression and an increase in osteoclasts. They just know that it exists. And, quoting from an abstract of their article, which appeared recently in the Journal of the Society of Biological Psychiatry, they note that "Premenopausal women who are psychiatrically diagnosed with major depression are particularly at high-risk for depression-associated low BMD [bone mass density]. Hence, periodic BMD measurements and anti-osteoporotic prophylactic and curative measures [osteoporosis treatment] are strongly advocated for these patients."

Another underlying cause of osteoporosis can be eating disorders. Young women with bulimia or anorexia are unable to absorb the amounts of calcium and vitamin D necessary to protect their bones. Depression can cause eating disorders; it can also be their result.

Do you see where we're going here? Young women are at risk of experiencing a vicious cycle of depression, eating disorders, and bone loss, all potentially leading to osteoporosis - at a discouragingly young age.

Bottom line: If you're a young woman being treated for depression, and/or for an eating disorder, be aware that your bones may be suffering - as well as your psyche.