Anxiety, depression associated with bone mass increases in young adults

Depression and generalized anxiety were linked with increasing bone mass in older adolescents and young adults, according to data from a cohort study. However, selective serotonin reuptake inhibitors were also associated with increasing bone mass among young women, but with decreasing bone mass in young men.

“[Major depressive disorder] is associated with low bone mass, increasing one’s lifetime risk for osteoporosis and fractures, as well as medical expenditures,” Chadi A. Calarge, MD, of the department of psychiatry and behavioral sciences at Baylor College of Medicine, and colleagues wrote. “The effects of [major depressive disorder] on bone mass have been attributed to dysregulation of the hypothalamic-pituitary-adrenal axis, other hormonal abnormalities, autonomic nervous system dysfunction and subclinical inflammation. … Additionally, psychotropic medications, particularly selective serotonin reuptake inhibitors (SSRIs), may accelerate bone loss and increase fracture risk.”

The researchers performed a longitudinal, observational cohort study of 264 medically healthy participants aged 15 to 20 years who were either unmedicated or had started SSRIs within 1 month of the study. Calarge and colleagues assessed patients’ medication use and psychiatric functioning each month, evaluated trabecular and cortical volumetric BMD every 4 months, and determined total body (less head) areal bone mineral content and lumbar spine areal BMD every 8 months. The researchers evaluated associations between bone measures and depression, anxiety and SSRI indices.

There was a significant increase from baseline in total body (less head) areal bone mineral content of 23.9 g/cm² (P < .0001), whereas a significant decrease from baseline of 2.7 mg/cm³ was noted in trabecular volumetric BMD at the ultradistal radius (P = .0002).

Depression severity was associated with increasing lumbar spine areal BMD, the researchers reported. In women, use of SSRIs was associated with increasing lumbar spine areal BMD, as well as bone formation. However, SSRI use in men was linked with decreasing lumbar spine areal BMD. There was a weak independent association between generalized anxiety disorder and increased bone mineralization, the researchers reported.

“In this prospective study of older adolescents and emerging adults, designed specifically to examine the association between depression, SSRI use and bone mass, a complex picture emerged, whereby depression was associated with low bone mass cross-sectionally, but with greater, site-specific bone mass accrual over time,” the researchers wrote. “In contrast, SSRI use was independently associated with a decrease in bone mass accrual in male participants and an increase in female [participants], again in a site-specific manner. … Future research should also explore mechanisms, as well as interventions to attenuate these treatment effects in males.” – by Andy Polhamus

Disclosures: The authors report no relevant financial disclosures.