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Farideh Eskandari, MD, MHSc; Pedro E. Martinez, MD; Sara Torvik, MSN; Terry M. Phillips, PhD; Esther M. Sternberg, MD; Sejal Mistry, BS; Donna Ronsaville, PhD; Robert Wesley, PhD; Caitlin Toomey, BS; Nancy G. Sebring, MEd; James C. Reynolds, MD; Marc R. Blackman, MD; Karim A. Calis, PharmD; Philip W. Gold, MD; Giovanni Cizza, MD, PhD, MHSc; for the Premenopausal, Osteoporosis Women, Alendronate, Depression (POWER) Study Group

Arch Intern Med. 2007;167(21):2329-2336.

Background  An increased prevalence of low bone mineral density (BMD) has been reported in patients with major depressive disorder (MDD), mostly women.

Methods  Study recruitment was conducted from July 1, 2001, to February 29, 2003. We report baseline BMD measurements in 89 premenopausal women with MDD and 44 healthy control women enrolled in a prospective study of bone turnover. The BMD was measured by dual-energy x-ray absorptiometry at the spine, hip, and forearm. Mean hourly levels of plasma 24-hour cytokines, 24-hour urinary free cortisol, and catecholamine excretion were measured in a subset of women. We defined MDD according to the Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition).

Results  The prevalence of low BMD, defined as a T score of less than –1, was greater in women with MDD vs controls at the femoral neck (17% vs 2%; P = .02) and total hip (15% vs 2%; P = .03) and tended to be greater at the lumbar spine (20% vs 9%; P = .14). The mean ± SD BMD, expressed as grams per square centimeters, was lower in women with MDD at the femoral neck (0.849 ± 0.121 vs 0.866 ± 0.094; P = .05) and at the lumbar spine (1.024 ± 0.117 vs 1.043 ± 0.092; P = .05) and tended to be lower at the radius (0.696 ± 0.049 vs 0.710 ± 0.055; P = .07). Women with MDD had increased mean levels of 24-hour proinflammatory cytokines and decreased levels of anti-inflammatory cytokines.

Conclusions  Low BMD is more prevalent in premenopausal women with MDD. The BMD deficits are of clinical significance and comparable in magnitude to those resulting from established risk factors for osteoporosis, such as smoking and reduced calcium intake. The possible contribution of immune or inflammatory imbalance to low BMD in premenopausal women with MDD remains to be clarified.

Trial Registration  clinicaltrials.gov Identifier: NCT00006180

Author Affiliations: Department of Medicine, Division of Clinical and Molecular Endocrinology, Case Western Reserve University, Cleveland, Ohio (Dr Eskandari); and Section on Neuroendocrine, Immunology, and Behavior, Integrative Neural Immune Program (Drs Eskandari and Sternberg), Clinical Neuroendocrinology Branch (Drs Martinez, Ronsaville, Gold, and Cizza), and Behavioral Endocrinology Branch (Dr Martinez), National Institute of Mental Health, Clinical Endocrinology Branch, National Institute of Diabetes and Digestive and Kidney Diseases (Drs Torvik and Cizza and Mss Mistry and Toomey), Biostatistics and Clinical Epidemiology Service (Dr Wesley), Department of Nutrition (Ms Sebring), Department of Nuclear Medicine (Dr Reynolds), Drug Information Service, Pharmacy Department (Dr Calis), Division of Bioengineering and Physical Science, Office of Research Services, Ultramicro Analytical Immunochemistry Resource (Dr Phillips), and Endocrine Section, Laboratory of Clinical Investigation, National Center for Complementary and Alternative Medicine (Dr Blackman), Mark O. Hatfield Clinical Research Center (Dr Blackman), National Institutes of Health, Bethesda, Maryland.

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