Recent research has found a bidirectional relationship between postmenopausal osteoporosis and depression. Medications and hormone replacement therapy can help treat both conditions and improve postmenopausal people’s quality of life.
Osteoporosis and depression are two health concerns that can affect women as they age.
While researchers often considered these conditions independent of one another, recent studies have highlighted a relationship between osteoporosis and depression.
Osteoporosis is the most common metabolic bone disease, affecting about 10 million Americans, 80% of whom are women.
After menopause, a woman’s bone mass tends to decrease faster due to falling estrogen levels. Postmenopausal osteoporosis is when the bones weaken because of low density, often becoming brittle and more susceptible to breaking.
The condition can affect a person’s quality of life, especially if they experience fractures, limited mobility, and pain.
Depression is the most common mood disorder, affecting 12% of women over the course of their lives. It stems from genetic, environmental, biological, and psychological factors.
Similarly, the link between postmenopausal osteoporosis and depression is multifaceted.
Estrogen reduction and depression
Some studies have found a relationship between postmenopausal osteoporosis and depression. However, many factors can come into play, making it challenging to understand how the two conditions may affect each other.
After menopause, the production of estrogen significantly decreases, which not only contributes to bone density loss but also impacts brain function. Low levels of estrogen can contribute to depression, especially during menopause and after menopause.
Estrogen is known to have a protective effect on the brain, influencing neurotransmitters such as serotonin and dopamine, which are critical for mood regulation. Falling estrogen may trigger sudden mood shifts, which can make it more difficult to cope with things that may have once been easy to let go of.
After menopause, estrogen levels decrease significantly and remain low, increasing the likelihood of both depression and osteoporosis.
However, studies have found that after menopause, women’s rates of depression tend to fall and are similar to men of the same age. That said, those with postmenopausal osteoporosis may remain susceptible to depression.
Emotional effects of osteoporosis
Chronic illnesses, including osteoporosis, can have adverse effects on mental health due to their psychosocial effects.
The weak and brittle bone associated with osteoporosis often leads to physical limitations, chronic pain, and an increased risk of fractures. These complications may result in increased anxiety, a loss of independence, and decreased quality of life.
Any of these factors can trigger or exacerbate depression. Increased anxiety about falling and the risk of injury may lead to reduced physical activity and social isolation, increasing the chance of depression.
Can depression cause osteoporosis?
Not only can osteoporosis potentially increase a woman’s chance of developing depression, but the relationship between depression and postmenopausal osteoporosis seems to be bidirectional.
Some studies have illustrated that individuals with depression are at a higher risk of developing osteoporosis.
However, this connection may be due to hormonal changes. Biological mechanisms, like the decrease in estrogen, are associated with both osteoporosis and depression.
Additionally, depression is associated with higher levels of inflammation in the body. In this inflammatory state, the body releases cytokines, which are small proteins responsible for cell processes.
In depression, some of these cytokines are associated with apoptosis (programmed cell death) of osteoclasts. These cells handle the normal process of bone breakdown, called resorption, so that new bone can form.
Normally, the breakdown of older bone and replacement with new bone keeps the skeletal structure strong and resilient. But as you age, new bone can’t form fast enough to keep up with the breakdown of old bone. Abnormal apoptosis of osteoclasts only exacerbates the problem, affecting bone health and resulting in weaker bones.
Increased levels of cortisol, also associated with depression, can lead to decreased bone density. Chronically high cortisol levels impair the activity of osteoblasts, which, when its function decreases, results in lower bone mineral density.
Furthermore, cortisol can prevent calcium absorption, contributing to decreased bone health.
Managing the condition with medications and hormones also plays a role in depression’s effect on the likelihood of osteoporosis.
The role of medications
There are various medications used to treat osteoporosis or depression, and some of them may help manage symptoms of both conditions.
Antidepressants and the risk of osteoporosis
Some studies suggest that antidepressants, like selective serotonin reuptake inhibitors (SSRIs), may weaken bones and increase the chance of developing osteoporotic features. However, researchers have not yet clearly established the link.
Two neurotransmitters, serotonin and norepinephrine, play a key role in regulating mood. They could also play a role in supporting bone mass regulation and health.
SSRIs are the most prescribed antidepressants. They work by blocking serotonin receptors in the brain, increasing serotonin levels. With more serotonin available, the communication between neurons improves, which contributes to improved mood regulation and decreased symptoms of depression.
However, SSRIs’ effect on serotonin may also disrupt the process of bone breakdown and buildup, potentially leading to accelerated bone loss and risk of fracture.
Still, researchers have not identified a clear link between antidepressants and osteoporosis.
Hormone replacement therapy (HRT)
Hormone replacement therapy (HRT) is sometimes used to manage both menopause symptoms, like osteoporosis and depression. It involves administering hormones, often estrogen or a combination of estrogen and progesterone, to help ease the symptoms caused by declining hormone levels.
With osteoporosis, HRT may help maintain or increase bone density, preventing the risk of fractures. HRT may also stabilize mood by regulating estrogen levels, resulting in decreased depressive symptoms.
Bisphosphonates
Bisphosphonates are medications that can help strengthen bones and reduce the risk of fractures. They’re generally prescribed to help slow the effects of osteoporosis.
Bisphosphonates work by slowing the natural process of bone breakdown (resorption). As a result, bone strength increases while the risk of fractures decreases.
In one 2016 study , a bisphosphonate called zoledronic acid increased bone mineral density and lower depression scores. Bisphosphonates might help with depression directly and indirectly.
These medications may help reduce inflammation and can restrict the growth of osteoclasts — the bone’s demolition crew. Improved bone health may affect levels of bone-derived hormones, such as osteocalcin, which can contribute to hormonal balance and, ultimately, mood.
Indirectly, bisphosphonates can support bone health, decreasing pain and worries about fractures while improving quality of life. As a result, individuals may be less likely to develop depression symptoms.
The takeaway
Historically, osteoporosis and depression have been thought of as two unrelated conditions. However, recent studies have highlighted the bidirectional relationship between postmenopausal osteoporosis and depression.
Biomechanisms like estrogen production and psychosocial effects may both play a role, as can various treatment methods, such as hormone replacement therapy.
A better understanding of the connection between postmenopausal osteoporosis and depression can significantly enhance the quality of life for postmenopausal people by addressing both their physical and mental health needs.
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