This Article Full Text Full Text (PDF) Services Download to citation manager PubMed PubMed Citation

Depression, Antidepressants, and Bone Mineral Density in a Population-Based Cohort

¹ Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor.
Departments of ² Mental Health and ⁴ Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
Divisions of ³ Endocrinology and Metabolism, and ⁵ Geriatric Psychiatry and Neuropsychiatry, Johns Hopkins University School of Medicine, Baltimore, Maryland.

Address correspondence to Briana Mezuk, PhD, 109 Observatory, SPH Tower Suite 3466, Ann Arbor, MI 48109. E-mail: bmezuk{at}umich.edu

Background. It is uncertain whether depression and antidepressant use are associated with decreased bone mineral density (BMD) and whether these relationships differ for men and women.

Methods. The study used a case-cohort design within the Baltimore Epidemiologic Catchment Area Study, a population-based sample of adults that recently completed its 23-year follow-up. Depression was measured at four time points during the follow-up period by the Diagnostic Interview Schedule. Lower spine BMD was measured at the fourth wave by dual-energy x-ray absorptiometry. The association of BMD with lifetime history of depression and antidepressant medication use was studied using linear regression with bootstrap standard errors.

Results. A history of depression was associated with lower spine BMD after controlling for age, sex, race, calcium intake, alcohol use, smoking status, level of physical activity, percent body fat, and antidepressant medication use (–0.140 g/cm²; p <.002). After controlling for depression, antidepressant medication use was associated with decreased BMD in women but not in men (–0.218 g/cm²; p <.016).

Conclusions. A history of depression predicted decreased lumbar spine BMD in men and women, and antidepressant use predicted decreased BMD in women even after controlling for depression. The magnitude of the effect of depression on BMD was approximately equivalent to 1 standard deviation in BMD and was therefore clinically significant. Providers should be aware of the physiologic consequences of depression as well as the possible risks to bone strength associated with antidepressant use in older patients.

Key Words: Depression • Antidepressants • Bone mineral density • Osteoporosis • Cohort study