Department of Internal Medicine, University of Messina, Policlinico G.Martino, Via C. Valeria 1, 98123, Messina, Italy.
Intern Emerg Med. 2013 Sep;8(6):485-91. doi: 10.1007/s11739-011-0628-1. Epub 2011 May 17.
Low bone mineral density, which increases the risk of stress fragility fractures, is a frequent, often persistent finding in patients with major depressive disorder (MDD). The clinical association between major depressive disorder and osteopenia is still unclear, although several factors are associated with a loss of bone mass. The aim of our study, therefore, was to evaluate bone mineral density and bone metabolism in patients with MDD. Bone mineral density was evaluated in fifty postmenopausal women with MDD, and in 50 matched postmenopausal control women by dual-energy X-ray absorptiometry of the lumbar spine and femur, and by ultrasonography of the calcaneus and phalanges. Serum levels of 25-hydroxivitamin D, parathyroid hormone, Osteoprotegerin/Receptor Activator for Nuclear Factor κB Ligand ratio, bone turnover markers, serum and urinary cortisol were examined. Bone mineral density of the lumbar spine (BMD: 0.72 ± 0.06 vs. 0.82 ± 0.09 g/cm(2), p < 0.001), femoral neck (BMD: 0.58 ± 0.04 vs. 0.71 ± 0.07 g/cm(2), p < 0.001) and total femur (BMD 0.66 ± 0.09 vs. 0.54 ± 0.06 g/cm(2), p < 0.001); and ultrasound parameters at calcaneus (SI: 81.30 ± 6.10 vs. 93.80 ± 7.10, p < 0.001) and phalanges (AD-SOS: 1915.00 ± 37.70 vs. 2020.88 ± 39.46, p < 0.001; BTT : 1.30 ± 0.8 vs. 1.45 ± 0.9, p < 0.001) are significantly lower in patients with MDD compared with controls. Moreover bone turnover markers, parathyroid hormone levels and Receptor Activator for Nuclear Factor κB Ligand are significantly higher in MDD patients compared with controls, while serum levels of 25-hydroxivitamin D and osteoprotegerin are significantly lower. There are no differences in urinary excretion and serum cortisol between groups. Postmenopausal women with depressive disorder have an elevated risk for osteoporosis. Our data suggest that a high level of parathyroid hormone may play a role in the pathogenetic process underlying osteopenia in these patients.
骨矿物质密度降低会增加应激性脆性骨折的风险，这是患有重度抑郁症（MDD）的患者常见的、经常持续存在的现象。虽然有一些因素与骨量丢失有关，但 MDD 与骨量减少之间的临床关联仍不清楚。因此，我们的研究目的是评估 MDD 患者的骨矿物质密度和骨代谢情况。我们通过腰椎和股骨的双能 X 射线吸收法以及跟骨和指骨的超声检查，评估了 50 名绝经后 MDD 患者和 50 名匹配的绝经后对照女性的骨矿物质密度。检测了血清 25-羟维生素 D、甲状旁腺激素、护骨素/核因子 κB 配体激活剂受体比值、骨转换标志物、血清和尿皮质醇水平。腰椎骨矿物质密度（BMD：0.72±0.06 比 0.82±0.09 g/cm²，p<0.001）、股骨颈 BMD（0.58±0.04 比 0.71±0.07 g/cm²，p<0.001）和全股骨 BMD（0.66±0.09 比 0.54±0.06 g/cm²，p<0.001）；以及跟骨超声参数（SI：81.30±6.10 比 93.80±7.10，p<0.001）和指骨超声参数（AD-SOS：1915.00±37.70 比 2020.88±39.46，p<0.001；BTT：1.30±0.8 比 1.45±0.9，p<0.001）在 MDD 患者中均显著低于对照组。此外，MDD 患者的骨转换标志物、甲状旁腺激素水平和核因子 κB 配体激活剂受体均显著高于对照组，而血清 25-羟维生素 D 和护骨素水平显著低于对照组。两组之间的尿钙排泄和血清皮质醇无差异。患有抑郁症的绝经后妇女骨质疏松症的风险增加。我们的数据表明，甲状旁腺激素水平升高可能在这些患者的骨量减少发病机制中起作用。
