Understanding Depression and Osteoporosis

People with osteoporosis (a condition that causes bones to become weak and brittle) are more likely to have depression (a serious mood disorder causing persistent sadness and loss of interest in activities) than people who do not have osteoporosis. One study found that nearly 87% of people with osteoporosis have mild to moderate depression. However, the reason behind the relationship is unclear.

In this article, learn more about the connection between depression and osteoporosis and why they are so closely related.

The Connection Between Depression and Osteoporosis

Researchers believe there is a connection between depression and osteoporosis. Many studies have shown that people with osteoporosis are more likely to have depression than those who do not have osteoporosis.

Based on these results, some scientists argue that depression should be considered a shared risk factor for osteoporosis, much like smoking and low calcium intake are.

Ways depression may increase the risk of osteoporosis include:

• Inflammation: Depression has been shown to cause increased inflammation in the body, which is associated with the breakdown of osteoclasts (a type of bone cell).
  
• Medications: Certain medications used to treat depression may affect bone density or increase the risk of falls and fractures.
• Shared risk factors: People with depression may have less sunlight exposure, physical activity, and poor nutrition, which are also risk factors for osteoporosis.
• Vitamin D: Low vitamin D levels are associated with depression and osteoporosis.

Other studies argue that depression cannot cause osteoporosis. Instead, they suggest that depression results from osteoporosis and the disease's physical limitations and symptoms.

Research Findings

A study from July 2022 found that 86.9% of people with osteoporosis had mild to moderate depression, compared to the group without osteoporosis, in which 15.4% had depression.

Importantly, this study had a case-control design, which means conclusions can only be made regarding the association between depression and osteoporosis, not whether one causes the other.

Another study, published in July 2021, investigated whether the genes predisposing someone to depression may also predispose them to osteoporosis.

The researchers of this study argued that the association between depression and osteoporosis could be explained by osteoporosis causing depression (rather than vice versa) and by shared risk factors, such as smoking, alcohol intake, and reduced physical activity.

Diagnosis of Depression and Osteoporosis

Osteoporosis is diagnosed via a bone density scan performed by a technician and assessed by a radiologist. Regular screenings are recommended for people with risk factors for osteoporosis.

Depression is diagnosed by a mental health provider, such as a licensed therapist or psychiatrist, based on guidelines from the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). This is the handbook that mental health providers use to diagnose all mental health disorders.

To be diagnosed with major depressive disorder, you must experience at least five of the following symptoms, including a depressed mood and loss of interest or pleasure, over the past two weeks:

• Depressed mood
• Fatigue and loss of energy
• Feelings of worthlessness and guilt
• Indecisiveness
• Loss of interest or pleasure
• Recurring thoughts of death or suicidal ideation (thoughts of or concepts about suicide)
  
• Slow thoughts and movement
  
• Weight or appetite change

Treatment of Depression and Osteoporosis

Osteoporosis is treated with lifestyle modifications, hormone therapy, and medications that can reduce or slow bone loss.

Depression is treated with medications, psychotherapy, and lifestyle changes.

Medications

Medication is one possible connection between depression and osteoporosis. Some scientists suggest that certain medications that treat depression may increase a person's risk of osteoporosis, including:

• Selective serotonin reuptake inhibitors (SSRIs) are a class of medications used to treat depression. Evidence is still emerging regarding SSRIs and bone health, but some scientists state that prolonged SSRI use can lead to a loss of bone density.
• Tricyclic antidepressants (TCAs) are another class of medications for depression that may have implications for osteoporosis. It is not yet clear how TCAs may affect bone density. However, they incur side effects such as vertigo (a dizzy sensation in which you feel the room around you is spinning) and balance issues that increase the risk of falls and fractures.

Your healthcare provider should also consider the risks of other medications you may be taking when prescribing medication for depression and osteoporosis. Drugs like opioids, antipsychotics, anticonvulsants, and benzodiazepines all increase risk of falls.

Psychotherapy

Psychotherapy is an evidence-based depression treatment involving talking to a therapist and sometimes engaging in prescribed activities.

Types of psychotherapy used to treat depression include:

• Cognitive behavioral therapy (CBT): There is a large body of evidence to support the effectiveness of CBT for treating depression. CBT is a type of talk therapy in which you bring awareness to negative thought patterns, learn how to challenge and change those thoughts, and modify your behaviors.
• Interpersonal therapy (IPT): This is a short-term talk therapy in which you examine how your relationships with others might affect your current emotional state.
• Psychodynamic therapy: This type of psychotherapy focuses on your early memories and experiences and how these might affect your current emotions.
  

Coping with Depression and Osteoporosis

Lifestyle Changes

Lifestyle changes are commonly recommended for people with depression and osteoporosis. Although these modifications won't cure either condition, they help manage each condition and give you a sense of control.

Some lifestyle change recommendations overlap with those recommended for managing osteoporosis. Some of these shared lifestyle changes include:

• Eating a healthy, balanced diet
• Increasing vitamin D
• Regular physical exercise
• Stress reduction techniques

Support Groups

Joining a support group could help you cope with depression and osteoporosis. Connecting with people living with the same conditions may instill a sense of solidarity.

Support groups for osteoporosis include:

• American Bone Health
• Bone Health & Osteoporosis Foundation (BHOF)
  

Support groups for depression include:

• Anxiety & Depression Association of America (ADAA)
• Depression and Bipolar Support Alliance
• Mental Health America
• National Alliance on Mental Illness (NAMI)

Summary

There is a strong association between depression and osteoporosis; most people with osteoporosis also have mild to moderate depression. However, the cause of this relationship is unclear. It is important to talk to your healthcare provider if you are experiencing symptoms of either.

A Word From Verywell

If you have osteoporosis, keeping an open conversation with your loved ones and healthcare providers about your mental health is essential. You are more likely to experience depression than a person without osteoporosis, so be aware of the symptoms of depression and consider screening for depression if you are experiencing symptoms.