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Depression and osteoporosis often go together. In one study, three-fourths of women with osteoporosis were found to also suffer from depression. But in recent years, researchers have begun to investigate an important chicken-and-egg question: Do patients become depressed because they have osteoporosis — or do they develop osteoporosis because they're depressed?
The Bone-Brain Connection
Scientific studies suggest that depression isn't only a result of osteoporosis — it may also be a cause. Yet the mechanism for this is still poorly understood. Does profound sadness cause molecular or biochemical changes that weaken bones? Or do medications that people take for depression affect bone health?
One study found that seniors who regularly took a common type of antidepressant — selective serotonin reuptake inhibitors (SSRIs), which includes Prozac and Seroxat — had twice the rate of fractures as people who weren't taking the drugs. People on the medications also had a higher risk of falling and lower bone density in the hip and spine.
It's far too early to declare that antidepressants contribute to osteoporosis. Nor would it be wise to toss out the prescription in hopes of protecting your bones. Even if antidepressants turn out to be implicated in bone loss, that should not be cause for stopping mental health treatment. Other medications, such as some chemotherapy drugs and anti-seizure prescriptions, are known to reduce bone density too — and no one suggests those be tossed out! But if you're on one of those meds, make sure your bone density is being monitored.
Indeed, it may turn out that depression itself — not the treatment — increases the risk of osteoporosis.
A Warning Sign
About one in five premenopausal women with major depression have low bone mass — in fact, the bone loss among depressed women is on a par with the loss seen in smokers, couch potatoes and women with diets low in calcium. Some studies suggest that depression triggers chemical or molecular changes in the sympathetic nervous and immune systems that promote bone loss. What's clear is that depression triggers lifestyle changes that are bad for bones.
"Depression does a lot of things, like markedly reduce your physical activity," explains Robert R. Recker, MD, president of the National Osteoporosis Foundation and director of the Osteoporosis Research Center at Creighton University. "When you are depressed, you want to crawl in a hole and pull the covers on top of you."
The fear of falling can also leave an osteoporosis patient a virtual prisoner in her home — socially isolated and physically inactive. This only worsens a patient's mind-set, not to mention the osteoporosis. If you find yourself suffering from the symptoms of depression — such as sadness, hopelessness, irritability, fatigue, insomnia, overeating or appetite loss — be sure to talk to your doctor.
If you're anxious about the possibility of falling, you may find it helpful to try meditation, deep breathing exercises, yoga or other relaxation techniques. Don't let fear cripple you.
Try This! Join an osteoporosis support group. It can be a great source of information and encouragement and give you a sense of belonging and camaraderie. Studies have shown that support groups can dramatically improve a person's outlook and quality of life. Find a group in your community at nof.org/patientinfo/support_groups.htm or by calling (800) 231-4222. —Julie Sevrens Lyons