Major depression and osteoporosis

Townsend Letter for Doctors and Patients, April, 2005 by Robert A. Anderson

Although pathogenesis of bone loss in major depressive disorder is still debated, studies of bone loss in nonpsychiatric medical disorders have found an association between the activation of osteoclastic (bone resorption) cells and elevation of proinflammatory cytokines. Bone mineral density assessed by dual-energy X-ray absorptiometry in 10 young women with borderline personality disorder plus current major depression was significantly lower than that of 20 healthy subjects and 16 patients with borderline personality disorder without depression. Levels of osteocalcin, serum cortisol, tumor necrosis factor-alpha (TNF-[alpha]), and interleukin-6 were significantly higher in the patients with borderline disorder plus current major depressive episode than in the healthy subjects. Patients with borderline personality disorder who did not have current or lifetime depression had no alterations of either BMD or immunological/hormonal measures.

Kahl KG, Rudolf S, Stoeckelhuber BM et al. Bone mineral density, markers of bone turnover, and cytokines in young women with borderline personality disorder with and without comorbid major depressive disorder. Am J Psychiatry 2005 Jan; 162(1):168-74.

Comment: Young women with concomitant borderline personality disorder and major depressive disorder had an elevated risk for osteoporosis. Borderline personality disorder alone is not associated with low BMD. These data suggest that the immune and endocrine disturbances associated with depressive disorders in the context of borderline personality disorder may play a role in the pathophysiological process underlying bone loss in the patients studied.