Archives of Osteoporosis

, 9:173 | Cite as

Depressive symptoms are not associated with forearm bone accrual during adolescence

  • Sara Lourenço
  • Raquel Lucas
  • Daniele Ferreira da Silva
  • Elisabete Ramos
  • Henrique Barros
Original Article

Abstract

Summary

Although depression has been associated to worst bone physical properties in adulthood, this study showed that depressive symptoms were not significantly associated to bone mineral density measured at the forearm during adolescence.

Purpose

Depressive conditions have been related to the reduction of bone mineral density (BMD) in adulthood. Though it is possible to hypothesize that depressive symptoms present similar effects in bone mineral accrual during adolescence, such association is poorly researched. Therefore, we aimed to study the relation between depressive symptoms and forearm BMD during adolescence.

Methods

The study is based on the Epidemiological Health Investigation of Teenagers cohort that sampled adolescents born in 1990 and enrolled in public and private schools of Porto during the 2003/2004 academic year. At baseline (n = 2,160) and at 17 years of age (n = 1,716), depressive symptoms were evaluated using the Beck Depression Inventory-II (BDI-II). BMD (grams per square centimetre) was measured at the non-dominant forearm using dual-energy X-ray absorptiometry. Sex-specific crude and adjusted linear regression coefficients (β) and the corresponding 95 % confidence intervals (95 % CIs) were calculated to estimate the cross-sectional and prospective associations between depressive symptoms and forearm BMD.

Results

In both sexes, in early and late adolescence, depressive symptoms presented no statistically significant association with forearm BMD (βGirls13 = 0.09, 95 % CI = −0.43 to 0.61; βGirls17 = 0.10, 95 % CI = −0.43 to 0.64; βBoys13 = −0.10, 95 % CI = −0.96 to 0.76; βBoys17 = 0.49, 95 % CI = −0.96 to 1.93). Similarly, there were no significant associations between depressive symptoms and the annual forearm BMD change during adolescence in girls and boys (βGirls_BDI-II_13-17_remained_lowest = −0.85, 95 % CI = −4.62 to 2.92 vs. βGirls_BDI-II_13-17_remained_highest = −1.87, 95 % CI = −5.06 to 1.31; βBoys_BDI-II_13-17_remained_lowest = 0.48, 95 % CI = −5.30 to 6.26 vs. βBoys_BDI-II_13-17_remained_highest = 1.36, 95 % CI = −3.25 to 5.97).

Conclusions

Depressive symptoms, with the range of severity observed in the general adolescent population, were not associated with changes in forearm bone mineral density during adolescence. Further research based on measurements of different skeletal sites is needed in order to detect a systemic effect of depression on growing bone.

Keywords

Depressive symptoms Bone mineral density Adolescence Population-based cohort 

References

  1. 1.
    Cizza G (2011) Major depressive disorder is a risk factor for low bone mass, central obesity, and other medical conditions. Dialogues Clin Neurosci 13:73–87PubMedCentralPubMedGoogle Scholar
  2. 2.
    Mezuk B, Eaton WW, Golden SH (2008) Depression and osteoporosis: epidemiology and potential mediating pathways. Osteoporos Int 19:1–12PubMedCentralPubMedCrossRefGoogle Scholar
  3. 3.
    Kann P, Laudes M, Piepkorn B, Heintz A, Beyer J (2001) Suppressed levels of serum cortisol following high-dose oral dexamethasone administration differ between healthy postmenopausal females and patients with established primary vertebral osteoporosis. Clin Rheumatol 20:25–29PubMedCrossRefGoogle Scholar
  4. 4.
    Ganesan K, Teklehaimanot S, Tran TH, Asuncion M, Norris K (2005) Relationship of C-reactive protein and bone mineral density in community-dwelling elderly females. J Natl Med Assoc 97:329–333PubMedCentralPubMedGoogle Scholar
  5. 5.
    Lake CR, Pickar D, Ziegler MG, Lipper S, Slater S, Murphy DL (1982) High plasma norepinephrine levels in patients with major affective disorder. Am J Psychiatry 139:1315–1318PubMedCrossRefGoogle Scholar
  6. 6.
    Raisz LG (1999) Physiology and pathophysiology of bone remodeling. Clin Chem 45:1353–1358PubMedGoogle Scholar
  7. 7.
    Khosla S, Melton LJ 3rd, Atkinson EJ, O'Fallon WM, Klee GG, Riggs BL (1998) Relationship of serum sex steroid levels and bone turnover markers with bone mineral density in men and women: a key role for bioavailable estrogen. J Clin Endocrinol Metab 83:2266–2274PubMedGoogle Scholar
  8. 8.
    Carnahan RM, Perry PJ (2004) Depression in aging men: the role of testosterone. Drugs Aging 21:361–376PubMedCrossRefGoogle Scholar
  9. 9.
    Richardson A, He JP, Curry L, Merikangas K (2012) Cigarette smoking and mood disorders in U.S. adolescents: sex-specific associations with symptoms, diagnoses, impairment and health services use. J Psychosom Res 72:269–275PubMedCrossRefGoogle Scholar
  10. 10.
    McCarty CA, Wymbs BT, King KM, Mason WA, Vander Stoep A, McCauley E, Baer J (2012) Developmental consistency in associations between depressive symptoms and alcohol use in early adolescence. J Stud Alcohol Drugs 73:444–453PubMedCentralPubMedGoogle Scholar
  11. 11.
    Lindwall M, Larsman P, Hagger MS (2011) The reciprocal relationship between physical activity and depression in older European adults: a prospective cross-lagged panel design using SHARE data. Health Psychol 30:453–462PubMedCrossRefGoogle Scholar
  12. 12.
    Yirmiya R, Bab I (2009) Major depression is a risk factor for low bone mineral density: a meta-analysis. Biol Psychiatry 66:423–432PubMedCrossRefGoogle Scholar
  13. 13.
    Wu Q, Liu J, Gallegos-Orozco JF, Hentz JG (2010) Depression, fracture risk, and bone loss: a meta-analysis of cohort studies. Osteoporos Int 21:1627–1635PubMedCrossRefGoogle Scholar
  14. 14.
    Cizza G, Primma S, Coyle M, Gourgiotis L, Csako G (2010) Depression and osteoporosis: a research synthesis with meta-analysis. Horm Metab Res 42:467–482PubMedCentralPubMedCrossRefGoogle Scholar
  15. 15.
    Lucas R, Fraga S, Ramos E, Barros H (2012) Early initiation of smoking and alcohol drinking as a predictor of lower forearm bone mineral density in late adolescence: a cohort study in girls. PLoS One 7:e46940PubMedCentralPubMedCrossRefGoogle Scholar
  16. 16.
    Lucas R, Ramos E, Oliveira A, Monjardino T, Barros H (2012) Low-grade systemic inflammation and suboptimal bone mineral density throughout adolescence: a prospective study in girls. Clin Endocrinol (Oxf) 77:665–671CrossRefGoogle Scholar
  17. 17.
    Davies JH, Evans BAJ, Gregory JW (2005) Bone mass acquisition in healthy children. Arch Dis Child 90:373–378PubMedCentralPubMedCrossRefGoogle Scholar
  18. 18.
    Steinberg L, Morris AS (2001) Adolescent development. Annu Rev Psychol 52:83–110PubMedCrossRefGoogle Scholar
  19. 19.
    Konstantynowicz J, Kadziela-Olech H, Kaczmarski M, Zebaze RM, Iuliano-Burns S, Piotrowska-Jastrzebska J, Seeman E (2005) Depression in anorexia nervosa: a risk factor for osteoporosis. J Clin Endocrinol Metab 90:5382–5385PubMedCrossRefGoogle Scholar
  20. 20.
    Dorn LD, Susman EJ, Pabst S, Huang B, Kalkwarf H, Grimes S (2008) Association of depressive symptoms and anxiety with bone mass and density in ever-smoking and never-smoking adolescent girls. Arch Pediatr Adolesc Med 162:1181–1188PubMedCentralPubMedCrossRefGoogle Scholar
  21. 21.
    Dorn LD, Pabst S, Sontag LM, Kalkwarf HJ, Hillman JB, Susman EJ (2011) Bone mass, depressive, and anxiety symptoms in adolescent girls: variation by smoking and alcohol use. J Adolesc Health 49:498–504PubMedCentralPubMedCrossRefGoogle Scholar
  22. 22.
    Ramos E, Barros H (2007) Family and school determinants of overweight in 13-year-old Portuguese adolescents. Acta Paediatr 96:281–286PubMedCrossRefGoogle Scholar
  23. 23.
    Beck A, Steer R, Brown G (1996) Manual for the Beck Depression Inventory-II. Psychological Corp., San AntonioGoogle Scholar
  24. 24.
    Coelho R, Martins A, Barros H (2002) Clinical profiles relating gender and depressive symptoms among adolescents ascertained by the Beck Depression Inventory II. Eur Psychiatry 17:222–226PubMedCrossRefGoogle Scholar
  25. 25.
    Fazeli PK, Mendes N, Russell M, Herzog DB, Klibanski A, Misra M (2013) Bone density characteristics and major depressive disorder in adolescents. Psychosom Med 75:117–123PubMedCentralPubMedCrossRefGoogle Scholar
  26. 26.
    APA (2000) Diagnostic criteria from DSM-IV-TR. American Psychiatric Association, WashingtonGoogle Scholar
  27. 27.
    Mezuk B, Eaton WW, Golden SH, Wand G, Lee HB (2008) Depression, antidepressants, and bone mineral density in a population-based cohort. J Gerontol A Biol Sci Med Sci 63:1410–1415PubMedCentralPubMedCrossRefGoogle Scholar
  28. 28.
    Wu Q, Bencaz AF, Hentz JG, Crowell MD (2012) Selective serotonin reuptake inhibitor treatment and risk of fractures: a meta-analysis of cohort and case–control studies. Osteoporos Int 23:365–375PubMedCrossRefGoogle Scholar
  29. 29.
    Smarr KL, Keefer AL (2011) Measures of depression and depressive symptoms: Beck Depression Inventory-II (BDI-II), Center for Epidemiologic Studies Depression Scale (CES-D), Geriatric Depression Scale (GDS), Hospital Anxiety and Depression Scale (HADS), and Patient Health Questionnaire-9 (PHQ-9). Arthritis Care Res 63(Suppl 11):S454–S466CrossRefGoogle Scholar
  30. 30.
    Lasa L, Ayuso-Mateos JL, Vazquez-Barquero JL, Diez-Manrique FJ, Dowrick CF (2000) The use of the Beck Depression Inventory to screen for depression in the general population: a preliminary analysis. J Affect Disord 57:261–265PubMedCrossRefGoogle Scholar
  31. 31.
    Sanchez-Villegas A, Schlatter J, Ortuno F, Lahortiga F, Pla J, Benito S, Martinez-Gonzalez MA (2008) Validity of a self-reported diagnosis of depression among participants in a cohort study using the Structured Clinical Interview for DSM-IV (SCID-I). BMC Psychiatry 8:43PubMedCentralPubMedCrossRefGoogle Scholar
  32. 32.
    Penninx BW, Milaneschi Y, Lamers F, Vogelzangs N (2013) Understanding the somatic consequences of depression: biological mechanisms and the role of depression symptom profile. BMC Med 11:129PubMedCentralPubMedCrossRefGoogle Scholar
  33. 33.
    Crabtree N, Ward K (2009) Bone densitometry: current status and future perspectives. Endocr Dev 16:58–72PubMedCrossRefGoogle Scholar
  34. 34.
    Flynn J, Foley S, Jones G (2007) Can BMD assessed by DXA at age 8 predict fracture risk in boys and girls during puberty?: an eight-year prospective study. J Bone Miner Res 22:1463–1467PubMedCrossRefGoogle Scholar
  35. 35.
    Weber-Hamann B, Hentschel F, Kniest A, Deuschle M, Colla M, Lederbogen F, Heuser I (2002) Hypercortisolemic depression is associated with increased intra-abdominal fat. Psychosom Med 64:274–277PubMedCrossRefGoogle Scholar
  36. 36.
    Zhao LJ, Jiang H, Papasian CJ, Maulik D, Drees B, Hamilton J, Deng HW (2008) Correlation of obesity and osteoporosis: effect of fat mass on the determination of osteoporosis. J Bone Miner Res 23:17–29PubMedCentralPubMedCrossRefGoogle Scholar
  37. 37.
    Anda RF, Williamson DF, Escobedo LG, Mast EE, Giovino GA, Remington PL (1990) Depression and the dynamics of smoking. A national perspective. JAMA 264:1541–1545PubMedCrossRefGoogle Scholar
  38. 38.
    Grant BF, Harford TC (1995) Comorbidity between DSM-IV alcohol use disorders and major depression: results of a national survey. Drug Alcohol Depend 39:197–206PubMedCrossRefGoogle Scholar
  39. 39.
    Kapoor D, Jones TH (2005) Smoking and hormones in health and endocrine disorders. Eur J Endocrinol 152:491–499PubMedCrossRefGoogle Scholar
  40. 40.
    Chakkalakal DA (2005) Alcohol-induced bone loss and deficient bone repair. Alcohol Clin Exp Res 29:2077–2090PubMedCrossRefGoogle Scholar
  41. 41.
    Camacho TC, Roberts RE, Lazarus NB, Kaplan GA, Cohen RD (1991) Physical activity and depression: evidence from the Alameda County Study. Am J Epidemiol 134:220–231PubMedGoogle Scholar
  42. 42.
    Korpelainen R, Korpelainen J, Heikkinen J, Vaananen K, Keinanen-Kiukaanniemi S (2006) Lifelong risk factors for osteoporosis and fractures in elderly women with low body mass index: a population-based study. Bone 39:385–391PubMedCrossRefGoogle Scholar
  43. 43.
    Zemel B (2013) Bone mineral accretion and its relationship to growth, sexual maturation and body composition during childhood and adolescence. World Rev Nutr Diet 106:39–45PubMedGoogle Scholar
  44. 44.
    Macdonald H, Kontulainen S, Petit M, Janssen P, McKay H (2006) Bone strength and its determinants in pre- and early pubertal boys and girls. Bone 39:598–608PubMedCrossRefGoogle Scholar
  45. 45.
    Monjardino T, Lucas R, Ramos E, Barros H (2012) Associations between a priori-defined dietary patterns and longitudinal changes in bone mineral density in adolescents. Public Health Nutr 13:1–11Google Scholar

Copyright information

© International Osteoporosis Foundation and National Osteoporosis Foundation 2014

Authors and Affiliations

  • Sara Lourenço
    • 1
  • Raquel Lucas
    • 1
    • 2
  • Daniele Ferreira da Silva
    • 1
  • Elisabete Ramos
    • 1
    • 2
  • Henrique Barros
    • 1
    • 2
  1. 1.Institute of Public Health of the University of PortoPortoPortugal
  2. 2.Department of Clinical Epidemiology, Predictive Medicine and Public HealthUniversity of Porto Medical SchoolPortoPortugal

Personalised recommendations