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Clinical Trial
. 2012;7(7):e40894.
doi: 10.1371/journal.pone.0040894. Epub 2012 Jul 27.

Do premenopausal women with major depression have low bone mineral density? A 36-month prospective study

Giovanni Cizza  1 , Sima Mistry, Vi T Nguyen, Farideh Eskandari, Pedro Martinez, Sara Torvik, James C Reynolds, Philip W Gold, Ninet Sinaii, Gyorgy Csako; POWER Study Group
Collaborators, Affiliations
Clinical Trial

Do premenopausal women with major depression have low bone mineral density? A 36-month prospective study

Giovanni Cizza et al. PLoS One. 2012.

Erratum in

  • PLoS One. 2012;7(10). doi:10.1371/annotation/193f2b29-b8b0-41e8-808a-290df5577a53. Sinai, Ninet [corrected to Sinaii, Ninet]

Abstract

Background: An inverse relationship between major depressive disorder (MDD) and bone mineral density (BMD) has been suggested, but prospective evaluation in premenopausal women is lacking.

Methods: Participants of this prospective study were 21 to 45 year-old premenopausal women with MDD (n = 92) and healthy controls (n = 44). We measured BMD at the anteroposterior lumbar spine, femoral neck, total hip, mid-distal radius, trochanter, and Ward's triangle, as well as serum intact parathyroid hormone (iPTH), ionized calcium, plasma adrenocorticotropic hormone (ACTH), serum cortisol, and 24-hour urinary-free cortisol levels at 0, 6, 12, 24, and 36 months. 25-hydroxyvitamin D was measured at baseline.

Results: At baseline, BMD tended to be lower in women with MDD compared to controls and BMD remained stable over time in both groups. At baseline, 6, 12, and 24 months intact PTH levels were significantly higher in women with MDD vs. controls. At baseline, ionized calcium and 25-hydroxyvitamin D levels were significantly lower in women with MDD compared to controls. At baseline and 12 months, bone-specific alkaline phosphatase, a marker of bone formation, was significantly higher in women with MDD vs. controls. Plasma ACTH was also higher in women with MDD at baseline and 6 months. Serum osteocalcin, urinary N-telopeptide, serum cortisol, and urinary free cortisol levels were not different between the two groups throughout the study.

Conclusion: Women with MDD tended to have lower BMD than controls over time. Larger and longer studies are necessary to extend these observations with the possibility of prophylactic therapy for osteoporosis.

Trial registration: ClinicalTrials.gov NCT 00006180.

Trial registration: ClinicalTrials.gov NCT00006180.

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Conflict of interest statement

Competing Interests: Alendronate and Placebo were generously provided by Merck Research Laboratories, Rahway, NJ. The informatics support for this study was provided by Mr. Frank Pierce from ®Esprit Health. Giovanni Cizza was a former Merck Employee and currently owns Merck stock options. This does not alter the authors' adherence to all the PLoS ONE policies on sharing data and materials.

Figures

Figure 1
Figure 1. Study flow diagram.
Note: The number of exclusions does not match the number of people as some participants were found to have more than one exclusionary criterion.
Figure 2
Figure 2. Hamilton depression (upper panel) and anxiety (lower panel) scores in women with MDD and control women over time.
Both depression and anxiety scores were relatively low and remained stable over time in women with MDD. As expected, scores for depression and anxiety were much higher in women with MDD vs. control women.
Figure 3
Figure 3. Bone mineral density measurements in women with MDD and moderate osteopenia or osteoporosis randomized to alendronate vs. placebo.
Over 12 months, the Alendronate group showed a significant increase in BMD at the lumbar spine (P = 0.003), and there was a trend for increased BMD at the femoral neck (P = 0.06). No changes over time were observed in the Placebo group.
See this image and copyright information in PMC

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