Bone mineral density in women with depression

N Engl J Med. 1996 Oct 17;335(16):1176-81. doi: 10.1056/NEJM199610173351602.


Background: Depression is associated with alterations in behavior and neuroendocrine systems that are risk factors for decreased bone mineral density. This study was undertaken to determine whether women with past or current major depression have demonstrable decreases in bone density.

Methods: We measured bone mineral density at the hip, spine, and radius in 24 women with past or current major depression and 24 normal women matched for age, body-mass index, menopausal status, and race, using dual-energy x-ray absorptiometry. We also evaluated cortisol and growth hormone secretion, bone metabolism, and vitamin D-receptor alleles.

Results: As compared with the normal women, the mean (+/-SD) bone density in the women with past or current depression was 6.5 percent lower at the spine (1.00+/-0.15 vs. 1.07+/-0.09 g per square centimeter, P=0.02), 13.6 percent lower at the femoral neck (0.76+/-0.11 vs. 0.88+/-0.11 g per square centimeter, P<0.001), 13.6 percent lower at Ward's triangle (0.70+/-0.14 vs. 0.81+/-0.13 g per square centimeter, P<0.001), and 10.8 percent lower at the trochanter (0.66+/-0.11 vs. 0.74+/-0.08 g per square centimeter, P<0.001). In addition, women with past or current depression had higher urinary cortisol excretion (71+/-29 vs. 51+/-19 micrograms per day [196+/-80 vs. 141+/-52 nmol per day], P=0.006), lower serum osteocalcin concentration (P=0.04), and lower urinary excretion of deoxypyridinoline (P=0.02).

Conclusions: Past or current depression in women is associated with decreased bone mineral density.

MeSH terms

  • Absorptiometry, Photon
  • Adult
  • Bone Density*
  • Bone and Bones / metabolism
  • Case-Control Studies
  • Depressive Disorder / metabolism
  • Depressive Disorder / physiopathology*
  • Female
  • Hip Joint / diagnostic imaging
  • Hip Joint / physiology
  • Hip Joint / physiopathology
  • Humans
  • Hydrocortisone / urine
  • Insulin-Like Growth Factor I / metabolism
  • Middle Aged
  • Radius / diagnostic imaging
  • Radius / physiology
  • Radius / physiopathology
  • Reference Values
  • Spine / diagnostic imaging
  • Spine / physiology
  • Spine / physiopathology


  • Insulin-Like Growth Factor I
  • Hydrocortisone