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By Traci Pedersen
Recurrent major depressive disorder (MDD) is associated with lower bone mineral density (BMD) in men, according to a new study from the University of Eastern Finland in collaboration with Deakin University, Australia. The use of antidepressants is also associated with lower BMD, but this link is dependent on weight and site of bone measurement.

Osteoporosis is a common health problem, particularly among postmenopausal women, and an underlying factor in fragility fractures. In the elderly, susceptibility to fracture and serious hip fractures can result in long-term hospitalization and decreased state of health.

Risk factors include low levels of physical activity, smoking, low intake of calcium and vitamin D, as well as certain medications and diseases. Lower bone density has also been linked to depression.

This might be due to depression-induced long-term stress and increased secretion of inflammatory markers. Selective serotonin reuptake inhibitors (SSRIs) used to treat depression have been shown to weaken bone health as well.

Although most studies have focused on postmenopausal women, the new study analyzed the association of single and recurrent MDD episodes and the use of antidepressants with bone density in men.

Between 2006 and 2011, 928 male participants (aged 24-98 years) completed a comprehensive questionnaire and had BMD assessments at the forearm, spine, total hip, and total body. MDD was identified using a structured clinical interview.

Nine percent of the study population had experienced a single MDD episode, and five percent had suffered from recurrent MDD. Furthermore, seven percent of the study participants reported the use of antidepressants at the time of assessment.

The findings showed that recurrent MDD was associated with lower BMD at the forearm (-6.5 percent) and total body (-2.5 percent) compared to men with no history of MDD, while single MDD episodes were associated with higher BMD at the total hip (+3.4 percent).

Antidepressant use was tied to lower BMD only in lower-weight men and varied across the bone sites. For example, the use of antidepressants was associated with reduced bone density in the hip in men weighing less than 242 pounds.

In the forearm, however, the association of anti-depressants with reduced bone density was not observed in men until their body weight was under 165 pounds.

Finally, the findings show that recurrent major depression may increase the risk of osteoporosis in men. Furthermore, the use of antidepressants should be taken into account as a potential risk factor of osteoporosis especially in men with a low body weight.

The study constitutes part of the Ph.D. project of Researcher Päivi Rauma, focusing on the effects of depression and antidepressants on bone health. The findings are published in the Journal of Musculoskeletal and Neuronal Interactions.

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