Section on Neuroendocrinology of Obesity, National Institutes of Diabetes and Digestive Kidney Diseases (NIDDK), National Institutes of Health, Bethesda, Maryland, United States of America.
PLoS One. 2012;7(7):e40894. doi: 10.1371/journal.pone.0040894. Epub 2012 Jul 27.
An inverse relationship between major depressive disorder (MDD) and bone mineral density (BMD) has been suggested, but prospective evaluation in premenopausal women is lacking.
Participants of this prospective study were 21 to 45 year-old premenopausal women with MDD (n = 92) and healthy controls (n = 44). We measured BMD at the anteroposterior lumbar spine, femoral neck, total hip, mid-distal radius, trochanter, and Ward's triangle, as well as serum intact parathyroid hormone (iPTH), ionized calcium, plasma adrenocorticotropic hormone (ACTH), serum cortisol, and 24-hour urinary-free cortisol levels at 0, 6, 12, 24, and 36 months. 25-hydroxyvitamin D was measured at baseline.
At baseline, BMD tended to be lower in women with MDD compared to controls and BMD remained stable over time in both groups. At baseline, 6, 12, and 24 months intact PTH levels were significantly higher in women with MDD vs. controls. At baseline, ionized calcium and 25-hydroxyvitamin D levels were significantly lower in women with MDD compared to controls. At baseline and 12 months, bone-specific alkaline phosphatase, a marker of bone formation, was significantly higher in women with MDD vs. controls. Plasma ACTH was also higher in women with MDD at baseline and 6 months. Serum osteocalcin, urinary N-telopeptide, serum cortisol, and urinary free cortisol levels were not different between the two groups throughout the study.
Women with MDD tended to have lower BMD than controls over time. Larger and longer studies are necessary to extend these observations with the possibility of prophylactic therapy for osteoporosis.
ClinicalTrials.gov NCT 00006180.
有研究提示重度抑郁症（MDD）与骨密度（BMD）之间呈负相关，但针对绝经前女性的前瞻性评估尚缺乏。
本前瞻性研究纳入了 92 例 MDD 绝经前女性患者和 44 例健康对照者。我们分别于 0、6、12、24、36 个月测量了两组患者的腰椎正侧位、股骨颈、全髋、桡骨中远 1/3 段、转子间和 Ward 三角处的 BMD，同时还检测了血清全段甲状旁腺素（iPTH）、离子钙、血浆促肾上腺皮质激素（ACTH）、血清皮质醇和 24 小时尿游离皮质醇水平，基线时还检测了 25-羟维生素 D。
基线时，MDD 组患者的 BMD 低于对照组，且两组患者的 BMD 均保持稳定。基线时、6 个月和 12 个月时，MDD 组患者的 iPTH 水平显著高于对照组。基线时，MDD 组患者的离子钙和 25-羟维生素 D 水平显著低于对照组。基线时和 12 个月时，MDD 组患者的骨特异性碱性磷酸酶（骨形成标志物）显著高于对照组。基线时和 6 个月时，MDD 组患者的血浆 ACTH 水平也更高。整个研究过程中，两组患者的血清骨钙素、尿 N-端肽、血清皮质醇和尿游离皮质醇水平均无差异。
与对照组相比，MDD 组患者的 BMD 随时间推移呈下降趋势。需要开展更大规模和更长时间的研究来进一步验证这些观察结果，并有可能开展针对骨质疏松症的预防性治疗。
ClinicalTrials.gov NCT 00006180。
