If you are among the nearly one-third of people with arthritis who live with anxiety and depression, you know that your emotional well-being can have a profound impact on your physical health. When you are depressed you may not eat healthfully, exercise or take your medication regularly. New research shows that being sad for a prolonged period of time can also have a negative effect on bone health in both men and women.
Happy Life Leads to Healthy Bones in Women
A 2014 study published in Psychosomatic Medicine found that bone density was 52% higher in postmenopausal women who reported feeling satisfied with their lives when compared with those who said they were unsatisfied. Participants were asked to measure their overall well-being in four areas: interest in life, happiness in life, ease of living and feelings of loneliness.
The researchers followed 1,147 Finnish women ages 60 to 70 for a period of 10 years. On average, bone density in all women weakened by 4% over the 10-year period. But they found that changes in life satisfaction had an effect on bone health. Participants whose well-being had deteriorated over the decade were found to have 85% weaker mineral bone density than those individuals whose spirits had improved.
“This is remarkable because not only depression, but also lower subjective well-being is associated with bone loss,” says Päivi Rauma, PharmD, lead author of the study and a researcher at the University of Eastern Finland. “This study underlines the importance of assessing subjective well-being in the general population, in addition to just a diagnosis-based approach.”
How depression and bone loss are related is not certain. Some research suggests that chronic sadness may cause biochemical changes in the body that weaken our bones.
“The mechanism of action in the relationship between life
dissatisfaction and bone loss is still unclear. We know chronic stress
has biological consequences. Increased levels of bone resorption and
systemic inflammation markers, which cause the bones to weaken, have been found in depression. Similar biological factors and mechanisms probably play a role in the relationship between life dissatisfaction and bone loss, but more research is needed,” explains Dr. Rauma.
Could our lifestyle choices also play a role? If you are depressed you may be less physically active and more likely to smoke, which contributes to poor bone health. In the study, Dr. Rauma controlled for confounding factors—including medication use, medical history and lifestyle factors—and found that life satisfaction was still independently associated to bone loss.
Depression Affects Bone Health in Men
Until now there has been little research exploring the relationship between mood and bone health in men. But a 2015 study published in the Journal of Musculoskeletal and Neuronal Interactions, found that men with recurrent major depressive disorder (MDD) had lower bone mineral density than those who were not depressed.
The study analyzed 928 men between the ages of 24 and 98 using data from the Geelong Osteoporosis Study, a population-based research project in Australia. Participants completed an initial assessment and then a follow-up one 5 years later.
Assessments included a questionnaire and structured clinical interview. Bone mineral density measurements were taken. Those men with recurrent MDD had 6.5% lower bone mineral density in the forearm and 2.5% lower density throughout the entire body when compared with men who were not depressed.
Treating Depression and Protecting Against Bone Loss
If you suffer from depression or other disorders that cause chronic pain, such as fibromyalgia, you may be treated with a class of antidepressant medications known as selective serotonin reuptake inhibitors (SSRIs). In addition to helping treat depression, SSRIs can help alleviate pain.
Previous studies have shown that taking SSRIs are a risk factor for lower bone density in women. Dr. Rauma’s research found that antidepressants were also associated with lower bone density in men.
If you have a diagnosis of depression, work with your physician to develop a treatment plan that balances relief from symptoms with the impact on your bone density.
“Depression needs to be treated, but the increased risk of osteoporosis should be noticed,” explains Dr. Rauma. “The first-line treatment for mild to moderate depression should be psychotherapy. More severe or chronic depression usually needs antidepressants as well.”
Be particularly cautious if you already have a diagnosis of osteopenia or osteoporosis, or increased risk factors for developing the disease. “For a person with an already heightened risk of osteoporosis, long-term treatment of depression with high doses of antidepressants should be monitored and interrupted if use is not required,” Dr. Rauma adds.