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Depression Hurts, Your Bones Included

 

Growing evidence suggests that depression, one of the most common diseases of the brain, is so powerful it can actually erode bones in the body.

Our bones are constantly remodeling themselves – they build themselves up and break themselves down over and over again. Depression is like a severe and prolonged state of stress on bones that may weaken them, making osteoporosis more likely. Depression causes blood pressure and heart rate to increase and also causes the brain to produce dangerously high levels of hormones – it has also been suggested that specific hormonal changes associated with depression lead to bone loss.

Someone suffering from depression might experience bouts of insomnia, loss of appetite, and overall lethargy, and these are all contributors to poor bone health. Studies show that older people with depression are more likely to have low bone mass than older people who aren’t depressed, and low bone mass is the biggest indicator of osteoporosis.

Younger women with depression may also be at risk for osteoporosis. One study found that among women who have not yet reached menopause, those with mild depression have less bone mass than those who aren’t depressed. Men who are depressed seem to lose bone even more rapidly and to a greater extent than women, however since bone density in men is greater to begin with, their risk of fracture may be slightly more forgiving than in women.

Medication
While currently available depression treatments are generally well tolerated and safe, some medications, including some antidepressants, anticonvulsants, and lithium, can increase your risk for osteoporosis. Certain medications can also increase your risk of falling, which is dangerous if you already have osteoporosis. The class of antidepressants known as SSRIs may be associated with higher rates of bone loss in older women.

A recent study funded by the NIH showed an association between SSRI use and hipbone loss in older women. In patients with depression and those on SSRIs, attention should be directed to the heightened risk of fragility fracture – a broken bone that’s caused by a fall from a standing height or less, indicating an underlying bone disorder like osteoporosis.

Lifestyle
If you have osteoporosis, you may need to make lifestyle changes, and these changes may actually increase your risk of depression. For example:

– To prevent falls that could cause already fragile bones to fracture or break, you may not be able to take part in some activities you once enjoyed.
– Weakened bones may make it harder to perform everyday tasks, and you could lose some of your independence.
– You may feel nervous about going to crowded places, such as malls or movie theaters, for fear of falling and breaking a bone.

But it can go the other way, too. Exercise is an important part of osteoporosis treatment, particularly activities in which you support your weight on your feet. These activities help to strengthen bones and muscles that can prevent falls and can also boost your mood and improve your depression.

People with depression and low bone mass need to try very hard to adopt bone health strategies, including use of supplements, quitting smoking, limiting alcohol consumption to fewer than two glasses a day, and participating in weight-bearing exercises and fall-prevention programs. Because early osteoporosis is primarily a silent disease, knowing that even mild depression can lead to bone loss years before fractures occur is of major clinical importance. Orthopedic surgeons should be aware of the association between depression and osteoporosis as well as the higher rate of bone loss in patients on SSRI medication for their depression. Treating depression can help you manage your osteoporosis and improve your overall health. Recovery from depression takes time but treatments are effective.

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