1
|
Liu C, Shi L, He J, Wang L, Min N, Wang F, Zhao M, Liu J, Zhang Y. Effects of depressive symptoms on osteoporotic bone metabolism and prognosis of joint replacement surgery in elderly male patients with femoral neck fracture. Asian J Surg 2023; 46:3687-3692. [PMID: 37422387 DOI: 10.1016/j.asjsur.2023.06.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 05/23/2023] [Accepted: 06/07/2023] [Indexed: 07/10/2023] Open
Abstract
OBJECTIVE To investigate the effect of depressive symptoms on osteoporotic bone metabolism and prognosis of joint replacement surgery in elderly male patients with femoral neck fractures. METHOD 102 elderly male patients with femoral neck fractures hospitalized in the Beijing Hospital from January 2017 to January 2019 were included. The patients with femoral neck fractures were divided into the depression group and the control group. The observation indicators included: bone mineral density, serum alkaline phosphatase, serum calcium, serum phosphorus, 25-hydroxy-vitamin D, osteocalcin, Type I procollagen amino-terminal propeptide, serum β-isomer of C-terminal telopeptide of type I collagen, hip function scores, and pain visual analogue scale at pre- and post-operative examinations. RESULTS The BMD was significantly lower in the depressed group than in the control group [either for lumbar spine or hip, P < 0.05]. Serum 25-(OH)-D levels and serum OC levels were lower (both P < 0.05) in the depression group, while serum -CTX levels were higher in the depression group than in the control group (P < 0.05). Depression severity (GDS score) was negatively correlated with BMD (r = -0.456, P < 0.05), 25(OH)D (r = -0.546, P < 0.05), and OC (r = -0.215, P < 0.05), while positively correlated with β-CTX (r = 0.372, P < 0.05). The Harris scores of the depression group were lower than the control group (P < 0.001). In the control group, VAS scores decrease at 12 months postoperatively while in the depressed group, VAS scores increased (P < 0.001). CONCLUSION Depression is a risk factor for low bone mineral density and fracture, and adversely affects functional recovery and pain relief after artificial femoral head replacement. Special care should be taken for those patients with depressive symptoms in orthopedic practice.
Collapse
Affiliation(s)
- Chi Liu
- Department of Orthopedics, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, PR China
| | - Lei Shi
- Department of Orthopedics, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, PR China
| | - Jing He
- Department of Neurology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, PR China
| | - Lin Wang
- Department of Orthopedics, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, PR China
| | - Nan Min
- Department of Orthopedics, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, PR China
| | - Fei Wang
- Department of Orthopedics, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, PR China
| | - Maoyu Zhao
- Department of Orthopedics, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, PR China
| | - Junchuan Liu
- Department of Orthopedics, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, PR China
| | - Yaonan Zhang
- Department of Orthopedics, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, PR China.
| |
Collapse
|
2
|
Huang CF, Pan PJ, Chiang YH, Yang SH. A Rehabilitation-Based Multidisciplinary Care Model Reduces Hip Fracture Mortality in Older Adults. J Multidiscip Healthc 2021; 14:2741-2747. [PMID: 34616155 PMCID: PMC8488040 DOI: 10.2147/jmdh.s331136] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 09/22/2021] [Indexed: 12/21/2022] Open
Abstract
Purpose In older adults, the one-year mortality rate after experiencing a hip fracture ranges between 8% and 36%. The purpose of this study was to look at the efficacy of rehabilitation-based multidisciplinary care for older individuals who had hip fractures. Patients and Methods The study included 185 people (aged 65 and over) with a history of hip fracture surgery between February 2014 and March 2017. A survey was conducted one month and six months following the operation to assess the recovery of 93 individuals who were part of a rehabilitation-based multidisciplinary care program and 92 patients who were getting standard therapy with surgery and unsupervised physical therapy. Results Physical activity, gait, balance evaluation, and depression scale ratings all had statistical significance (P < 0.05) after participants received rehabilitation-based care services from multidisciplinary medical professionals. Furthermore, the refracture and one-year mortality rates in this rehabilitation-based multidisciplinary care model were lower than in the groups getting standard therapy. Conclusion The research indicates the efficacy of a multidisciplinary rehabilitation strategy provided by a collaborative medical team to older individuals with hip fractures.
Collapse
Affiliation(s)
- Chun-Feng Huang
- Department of Family Medicine, National Yang Ming Chiao Tung University Hospital, Yilan, Taiwan (R.O.C).,Department of Leisure Services Management, Chaoyang University of Technology, Taichung, Taiwan (R.O.C)
| | - Po-Jung Pan
- Department of Physical Medicine and Rehabilitation, National Yang Ming Chiao Tung University Hospital, Yilan, Taiwan (R.O.C)
| | - Yi-Hung Chiang
- Department of Orthopedics, National Yang Ming Chiao Tung University Hospital, Yilan, Taiwan (R.O.C)
| | - Shung-Haur Yang
- Department of Surgery, National Yang Ming Chiao Tung University Hospital, Yilan, Taiwan (R.O.C)
| |
Collapse
|
3
|
Mutz J, Lewis CM. Lifetime depression and age-related changes in body composition, cardiovascular function, grip strength and lung function: sex-specific analyses in the UK Biobank. Aging (Albany NY) 2021; 13:17038-17079. [PMID: 34233295 PMCID: PMC8312429 DOI: 10.18632/aging.203275] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 06/19/2021] [Indexed: 12/27/2022]
Abstract
Individuals with depression, on average, die prematurely, have high levels of physical comorbidities and may experience accelerated biological ageing. A greater understanding of age-related changes in physiology could provide novel biological insights that may help inform strategies to mitigate excess mortality in depression. We used generalised additive models to examine age-related changes in 15 cardiovascular, body composition, grip strength and lung function measures, comparing males and females with a lifetime history of depression to healthy controls. The main dataset included 342,393 adults (mean age = 55.87 years, SD = 8.09; 52.61% females). We found statistically significant case-control differences for most physiological measures. There was some evidence that age-related changes in body composition, cardiovascular function, lung function and heel bone mineral density followed different trajectories in depression. These differences did not uniformly narrow or widen with age and differed by sex. For example, BMI in female cases was 1.1 kg/m2 higher at age 40 and this difference narrowed to 0.4 kg/m2 at age 70. In males, systolic blood pressure was 1 mmHg lower in depression cases at age 45 and this difference widened to 2.5 mmHg at age 65. These findings suggest that targeted screening for physiological function in middle-aged and older adults with depression is warranted to potentially mitigate excess mortality.
Collapse
Affiliation(s)
- Julian Mutz
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, Greater London SE5 8AF, United Kingdom
| | - Cathryn M. Lewis
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, Greater London SE5 8AF, United Kingdom
- Department of Medical and Molecular Genetics, Faculty of Life Sciences and Medicine, King’s College London, London, Greater London SE1 9RT, United Kingdom
| |
Collapse
|
4
|
Klima DW, Davey A. Screening Gait Performance, Falls, and Physical Activity among Benedictine and Trappist Monks. J Prim Care Community Health 2021; 12:2150132721990187. [PMID: 33522368 PMCID: PMC8772351 DOI: 10.1177/2150132721990187] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
Background and Objective: Physical performance in older men has been reported in analyses with veterans and in disease-based cohort research. Studies examining gait performance among older monks, however, are narrow. The purpose of this study was to analyze the impact of a recent fall on gait ability in a cohort of Benedictine and Trappist monks in 4 US monastic communities. The second aim was to analyze physical activity and a recent fall as predictive markers of 2 constructs of gait performance. Methods: In this cross-sectional study, 53 Benedictine and Trappist monks over 60 (x = 74.7 ± 7.6; range: 61-94 years) completed a basic sociodemographic and fall history profile, the Timed Up and Go (TUG) Test, Dynamic Gait Index (DGI) and the Physical Activity Scale for the Elderly (PASE). Results: Demographic profiles revealed that 10% of participants had fallen over the past 3 months; in addition, those who had fallen were more likely to limit activities because of fear of falling (P = .005). Monks who had fallen over the past 3 months demonstrated significantly poorer TUG (12.6 ± 2.1 vs 10.5 ± 1.8; P = .01) and DGI (17.2 ± 5.3 vs 22.3 ± 2.3; P < .001) scores. There was a significant association between physical activity and both the TUG (–0.55; P < .001) and DGI (64; P < .001). Multiple regression models demonstrated that physical activity and a fall in the past 3 months predicted 24% of the variance in the TUG (P < .001) and 46% of the variance in the DGI (P < .001). Conclusions: Gait performance is linked to a recent fall episode among older monks. Predictive determinants of functional mobility (TUG) and superimposing tasks on the gait cycle (DGI) include recent fall history and physical activity. Appropriate health promotion activities can be aligned with these lifestyle attributes in monastic communities.
Collapse
Affiliation(s)
- Dennis W Klima
- University of Maryland Eastern Shore, Princess Anne, MD, USA
| | | |
Collapse
|
5
|
Acute ketamine administration corrects abnormal inflammatory bone markers in major depressive disorder. Mol Psychiatry 2018; 23:1626-1631. [PMID: 28555075 PMCID: PMC5709243 DOI: 10.1038/mp.2017.109] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2017] [Revised: 03/16/2017] [Accepted: 04/04/2017] [Indexed: 12/21/2022]
Abstract
Patients with major depressive disorder (MDD) have clinically relevant, significant decreases in bone mineral density (BMD). We sought to determine if predictive markers of bone inflammation-the osteoprotegerin (OPG)-RANK-RANKL system or osteopontin (OPN)-play a role in the bone abnormalities associated with MDD and, if so, whether ketamine treatment corrected the abnormalities. The OPG-RANK-RANKL system plays the principal role in determining the balance between bone resorption and bone formation. RANKL is the osteoclast differentiating factor and diminishes BMD. OPG is a decoy receptor for RANKL, thereby increasing BMD. OPN is the bone glue that acts as a scaffold between bone tissues matrix composition to bind them together and is an important component of bone strength and fracture resistance. Twenty-eight medication-free inpatients with treatment-resistant MDD and 16 healthy controls (HCs) participated in the study. Peripheral bone marker levels and their responses to IV ketamine infusion in MDD patients and HCs were measured at four time points: at baseline, and post-infusion at 230 min, Day 1, and Day 3. Patients with MDD had significant decreases in baseline OPG/RANKL ratio and in plasma OPN levels. Ketamine significantly increased both the OPG/RANKL ratio and plasma OPN levels, and significantly decreased RANKL levels. Bone marker levels in HCs remained unaltered. We conclude that the OPG-RANK-RANKL system and the OPN system play important roles in the serious bone abnormalities associated with MDD. These data suggest that, in addition to its antidepressant effects, ketamine also has a salutary effect on a major medical complication of depressive illness.
Collapse
|
6
|
Abstract
UNLABELLED This meta-analysis pooled results from 23 qualifying individual cohort studies and found that depression was significantly associated with an increased risk of fractures and bone loss. INTRODUCTION The association between depression and risk of fracture remains controversial. We conducted a comprehensive meta-analysis to examine the effect of depression on the risk of osteoporotic fractures and bone loss. METHODS We searched databases and reviewed citations in relevant articles for eligible cohort studies. Two investigators independently conducted study selection, appraisal, and data abstraction through the use of a standardized protocol. Random effect models were used for meta-analysis. Cochrane Q and I2 statistics were used to assess heterogeneity. Funnel plots and rank correlation tests were used to evaluate publication bias. RESULTS Twenty-three studies were included for meta-analysis. In studies that reported hazard ratio (HR) as the outcome (nine studies [n = 309,862]), depression was associated with 26% increase in fracture risk (HR = 1.26, 95% CI, 1.10-1.43, p < 0.001). Studies that reported risk ratio (RR) as the outcome (seven studies [n = 64,975]) suggested that depression was associated with 39% increase in fracture risk (RR = 1.39, 95% CI, 1.19-1.62, p < 0.001). Among studies that reported hip bone mineral density (BMD) as an outcome (eight studies [n = 15,442]), depression was associated with a reduced mean annual bone loss rate of 0.35% (0.18-0.53%, p < 0.001). The increased risk of fracture and bone loss associated with depression was consistent in all meta-analysis having modified inclusion criteria and in different subgroup analyses as well. Significant heterogeneity was observed in the meta-analysis; however, no significant publication bias was detected. CONCLUSION Depression is associated with a significant increased risk in fracture and bone loss. Effective prevention may decrease such risk.
Collapse
Affiliation(s)
- Q Wu
- Nevada Institute of Personalized Medicine, Department of Environmental & Occupational Health School of Community Health Sciences, University of Nevada, Las Vegas, NV, 89154, USA.
| | - B Liu
- Nevada Institute of Personalized Medicine, Department of Environmental & Occupational Health School of Community Health Sciences, University of Nevada, Las Vegas, NV, 89154, USA
- Department of Mathematical Science, University of Nevada, Las Vegas, NV, USA
| | - S Tonmoy
- Department of Mathematical Science, University of Nevada, Las Vegas, NV, USA
| |
Collapse
|
7
|
|
8
|
Abstract
Recent meta-analyses report a 70 % increase in fracture risk in selective serotonin reuptake inhibitor (SSRI) users compared to non-users; however, included studies were observational and limited in their ability to establish causality. Here, we use the Bradford Hill criteria to explore causality between SSRIs and fractures. We found a strong, consistent, and temporal relationship between SSRIs and fractures, which appears to follow a biological gradient. However, specificity and biological plausibility remain concerns. In terms of specificity, the majority of available data have limitations due to either confounding by indication or channeling bias. Self-controlled case series address some of these limitations and provide relatively strong observational evidence for a causal relationship between SSRIs and fracture. In doing so, they suggest that falls contribute to fractures in SSRI users. Whether there are also underlying changes in skeletal properties remains unresolved. Initial studies provide some evidence for skeletal effects of SSRIs; however, the pathways involved need to be established before biological plausibility can be accepted. As the link between SSRIs and fractures is based on observational data and not evidence from prospective trials, there is insufficient evidence to definitively determine a causal relationship and it appears premature to label SSRIs as a secondary cause of osteoporosis. SSRIs appear to contribute to fracture-inducing falls, and addressing any fall risk associated with SSRIs may be an efficient approach to reducing SSRI-related fractures. As fractures stemming from SSRI-induced falls are more likely in individuals with compromised bone health, it is worth considering bone density testing and intervention for those presenting with risk factors for osteoporosis.
Collapse
Affiliation(s)
- Stuart J Warden
- Center for Translational Musculoskeletal Research and Department of Physical Therapy, School of the Health and Rehabilitation Sciences, Indiana University, 1140 W. Michigan St., CF-120, Indianapolis, IN, USA.
| | - Robyn K Fuchs
- Center for Translational Musculoskeletal Research and Department of Physical Therapy, School of the Health and Rehabilitation Sciences, Indiana University, 1140 W. Michigan St., CF-120, Indianapolis, IN, USA
| |
Collapse
|
9
|
Cheng BH, Chen PC, Yang YH, Lee CP, Huang KE, Chen VC. Effects of depression and antidepressant medications on hip fracture: A population-based cohort study in Taiwan. Medicine (Baltimore) 2016; 95:e4655. [PMID: 27603358 PMCID: PMC5023880 DOI: 10.1097/md.0000000000004655] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
This study was conducted to investigate the effects of depression and antidepressant medications on hip fracture. The database of the Taiwan National Health Insurance with medical records of more than 1,000,000 individuals was searched for patients who had hip fracture with or without depression from 1998 to 2009. Patients with the following conditions were excluded: hip fracture due to cancer or traffic accidents, hip fracture that occurred before the diagnosis of depression, and use of antidepressants before the diagnosis of depression. A matched cohort of 139,110 patients was investigated, including 27,822 (17,309 females; 10,513 males) with depression and 111,288 (69,236 females; 42,052 males) without depression (1:4 randomly matched with age, sex, and index date). Among these patients, 232 (158 females and 74 males) had both hip fracture and depression, and 690 (473 females and 217 males) had hip fracture only. The Cox proportional-hazards regression method was used to determine the effect of depression on hip fracture. The hazard ratio (HR) for each clinical parameter was calculated after adjusting for confounders including sex, age, Charlson comorbidity index, urbanization, osteoporosis, and antidepressants. Results showed that patients with major depressive disorder had a 61% higher incidence of hip fracture than those without depression (HR 1.61, 95% confidence interval [CI] 1.19-2.18, P = 0.002). The risk of hip fracture for patients with less severe depressive disorder (dysthymia or depressive disorder, not otherwise specified) was not statistically higher than that of patients with no depression (HR 1.10, 95% CI = 0.91-1.34, P = 0.327). Among the patients with depression, females had a 49% higher incidence for hip fracture than males (HR 1.49, 95% CI 1.30-1.72, P < 0.001). The incidence of hip fracture also increased with age and Charlson comorbidity index scores. Analyses of both all (139,110) patients and only patients (27,822) with depression revealed that antidepressants had no negative impact on the incidence of hip fracture. In conclusion, major depression was found to be a risk factor for hip fracture and that use of antidepressants had no adverse effect on hip fracture in the Taiwanese population.
Collapse
Affiliation(s)
- Bi-Hua Cheng
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Chiayi
| | - Pau-Chung Chen
- Institute of Occupational Medicine and Industrial Hygiene, National Taiwan University, Taipei
| | | | - Chuan-Pin Lee
- Center of Excellence for Chang Gung Research Data Link, Chang Gung Memorial Hospital, Chiayi
| | - Ko-En Huang
- Department of Obstetrics and Gynecology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine
- Correspondence: Vincent C. Chen, Chang Gung Medical Foundation, Chang Gung Memorial Hospital, Chiayi, Taiwan (e-mail: ); Ko-En Huang, Department of Obstetrics and Gynecology, Kaohsiung Chang Gung Memorial Hospital, Taiwan (e-mail: )
| | - Vincent C. Chen
- Chang Gung Medical Foundation, Chang Gung Memorial Hospital, Chiayi, Taiwan
- Correspondence: Vincent C. Chen, Chang Gung Medical Foundation, Chang Gung Memorial Hospital, Chiayi, Taiwan (e-mail: ); Ko-En Huang, Department of Obstetrics and Gynecology, Kaohsiung Chang Gung Memorial Hospital, Taiwan (e-mail: )
| |
Collapse
|
10
|
Schweiger JU, Schweiger U, Hüppe M, Kahl KG, Greggersen W, Fassbinder E. Bone density and depressive disorder: a meta-analysis. Brain Behav 2016; 6:e00489. [PMID: 27547495 PMCID: PMC4980464 DOI: 10.1002/brb3.489] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Revised: 03/13/2016] [Accepted: 04/01/2016] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND The aim of this study was to evaluate the evidence of low bone mineral density (BMD) in depression. Low BMD is a major risk factor for osteoporotic fractures and frailty. METHODS The searched database was Pubmed, Meta-analysis included human studies in men and women fulfilling the following criteria: (1) assessment of BMD in the lumbar spine, the femur or the total hip; (2) comparison of BMD between depressed individuals and the healthy control group; (3) measurement of BMD using dual-energy X-ray absorptiometry (DEXA); and (4) data on the mean, standard deviation, or standard error of BMD. RESULTS Twenty-one studies were identified, encompassing 1842 depressed and 17,401 nondepressed individuals. Significant negative composite weighted mean effect sizes were identified for the lumbar spine (d = -0.15, 95%CL -0.22 to -0.08), femur (d = -0.34, 95%CL -0.64 to -0.05), and total hip (d = -0.14, 95%CL -0.23 to -0.05) indicating low BMD in depression. Examining men and women shows low bone density in the lumbar spine and femur in women and low bone density in the hip in men. The differences between men and women with MDD and the comparison group tended to be higher when examined by expert interviewers. Low bone density was found in all age groups. CONCLUSIONS Bone mineral density is reduced in patients with depressive disorders. The studies provide little evidence for potential relevant mediating factors.
Collapse
Affiliation(s)
| | - Ulrich Schweiger
- Department of Psychiatry and Psychotherapy Lübeck University Medical School Lübeck Germany
| | - Michael Hüppe
- Department of Anesthesiology Lübeck University Medical School Lübeck Germany
| | - Kai G Kahl
- Department of Psychiatry, Social Psychiatry and Psychotherapy Hannover Medical School Hannover Germany
| | - Wiebke Greggersen
- Department of Psychiatry and Psychotherapy Lübeck University Medical School Lübeck Germany
| | - Eva Fassbinder
- Department of Psychiatry and Psychotherapy Lübeck University Medical School Lübeck Germany
| |
Collapse
|
11
|
Feldcamp L, Doucet JS, Pawling J, Fadel MP, Fletcher PJ, Maunder R, Dennis JW, Wong AHC. Mgat5 modulates the effect of early life stress on adult behavior and physical health in mice. Behav Brain Res 2016; 312:253-64. [PMID: 27329152 DOI: 10.1016/j.bbr.2016.06.033] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2016] [Revised: 06/05/2016] [Accepted: 06/15/2016] [Indexed: 12/20/2022]
Abstract
Psychosocial adversity in early life increases the likelihood of mental and physical illness, but the underlying mechanisms are poorly understood. Mgat5 is an N-acetylglucosaminyltransferase in the Golgi pathway that remodels the N-glycans of glycoproteins at the cell surface. Mice lacking Mgat5 display conditional phenotypes in behaviour, immunity, metabolism, aging and cancer susceptibility. Here we investigated potential gene-environment interactions between Mgat5 and early life adversity on behaviour and physiological measures of physical health. Mgat5(-/-) mutant and Mgat5(+/+) wild-type C57Bl/6 littermates were subject to maternal separation or foster rearing as an early life stressor, in comparison to control mice reared normally. We found an interaction between Mgat5 genotype and maternal rearing condition in which Mgat5(-/-) mice subjected to early life stress had lower glucose levels and higher bone density. Mgat5(-/-) genotype was also associated with less immobility in the forced swim test and greater sucrose consumption, consistent with a less depression-like phenotype. Cortical neuron dendrite spine density and branching was altered by Mgat5 deletion as well. In general, Mgat5 genotype affects both behaviour and physical outcomes in response to early life stress, suggesting some shared pathways for both in this model. These results provide a starting point for studying the mechanisms by which protein N-glycosylation mediates the effects of early life adversity.
Collapse
Affiliation(s)
- Laura Feldcamp
- Institute of Medical Science, University of Toronto, Medical Sciences Building, 1 King's College Circle, Room 2374, Toronto, Ontario, M5S 1A8, Canada; Campbell Family Mental Health Research Institute, Center for Addiction and Mental Health, 250 College Street, Toronto, Ontario, M5T 1R8, Canada
| | - Jean-Sebastien Doucet
- Campbell Family Mental Health Research Institute, Center for Addiction and Mental Health, 250 College Street, Toronto, Ontario, M5T 1R8, Canada
| | - Judy Pawling
- Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, 600 University Ave., Toronto, Ontario, M5G 1X5, Canada
| | - Marc P Fadel
- Ontario Shores Centre for Mental Health Sciences, 700 Gordon St, Whitby, Ontario, Canada; Department of Psychiatry, University of Toronto, 250 College Street, 8th Floor, Toronto, Ontario, M5T 1R8, Canada
| | - Paul J Fletcher
- Campbell Family Mental Health Research Institute, Center for Addiction and Mental Health, 250 College Street, Toronto, Ontario, M5T 1R8, Canada
| | - Robert Maunder
- Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, 600 University Ave., Toronto, Ontario, M5G 1X5, Canada; Department of Psychiatry, University of Toronto, 250 College Street, 8th Floor, Toronto, Ontario, M5T 1R8, Canada
| | - James W Dennis
- Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, 600 University Ave., Toronto, Ontario, M5G 1X5, Canada; Department of Molecular Genetics, University of Toronto, Medical Sciences Building, Room 4386, 1 King's College Circle, Toronto, Ontario, M5S 1A8, Canada; Department of Laboratory Medicine and Pathology, University of Toronto, Medical Sciences Building, 1 King's College Circle, 6th Floor, Toronto, Ontario, M5S 1A8, Canada
| | - Albert H C Wong
- Institute of Medical Science, University of Toronto, Medical Sciences Building, 1 King's College Circle, Room 2374, Toronto, Ontario, M5S 1A8, Canada; Campbell Family Mental Health Research Institute, Center for Addiction and Mental Health, 250 College Street, Toronto, Ontario, M5T 1R8, Canada; Department of Psychiatry, University of Toronto, 250 College Street, 8th Floor, Toronto, Ontario, M5T 1R8, Canada; Department of Pharmacology, University of Toronto, Medical Sciences Building, Rm 4207, 1 King's College Circle, Toronto, Ontario, M5S 1A8, Canada,.
| |
Collapse
|
12
|
Depression and Reduced Bone Mineral Density at the Hip and Lumbar Spine: A Comparative Meta-Analysis of Studies in Adults 60 Years and Older. Psychosom Med 2016; 78:492-500. [PMID: 26716814 DOI: 10.1097/psy.0000000000000292] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE Older adults with depression are more likely to experience fractures, but it is unclear if this group has reduced bone mineral density (BMD). We conducted a systematic review and meta-analysis to compare BMD in older adults (60 years or older) with or without depression. METHODS Two independent authors conducted searches of major electronic databases from inception till April 2015. Articles that measured BMD (in g/cm) by dual-energy x-ray absorptiometry at the hip or lumbar spine in a sample with depression (including those with major depressive disorder and depressive symptoms, henceforth called "depression") and a control group were included. A random-effects meta-analysis and meta-regression were conducted. RESULTS Eleven publications across 10 unique studies representing 2511 participants with depression (mean [standard deviation] = 67.4 [6.5] years, 41.8% female) and 32,574 matched controls (mean [standard deviation] = 67.5 [5.9] years, 38.9% female) were included. Only one study confirmed a diagnosis of major depressive disorder, seven studies used a screening measure to define depressive symptoms, and two studies categorized depression by antidepressant medication use. Meta-analysis established that BMD is reduced at the hip in older adults with depression (g = -0.141, 95% confidence interval = -0.220 to -0.062, p < .0001, I = 61%). Meta-analysis from seven studies suggests that lumbar spine BMD may be reduced (g = -0.122, 95% confidence interval = -0.250 to 0.005, p = .06, I = 71%). CONCLUSIONS Hip BMD is reduced in older adults with depression, although the effect size is small. Nevertheless, considering the deleterious impact of hip fractures in this population, the results are important. Future research should seek to disentangle the independent effects of depression and antidepressant medication on bone loss in older age.
Collapse
|
13
|
Hip Fracture in People with Erectile Dysfunction: A Nationwide Population-Based Cohort Study. PLoS One 2016; 11:e0153467. [PMID: 27078254 PMCID: PMC4831780 DOI: 10.1371/journal.pone.0153467] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2015] [Accepted: 03/30/2016] [Indexed: 01/30/2023] Open
Abstract
The aims of this study were to investigate the risk of hip fracture and contributing factors in patients with erectile dysfunction(ED). This population-based study was performed using the Taiwan National Health Insurance Research Database. The analysis included4636 patients aged ≥ 40 years who had been diagnosed with ED (International Classification of Diseases, Ninth Revision, Clinical Modification codes 302.72, 607.84) during 1996–2010. The control group included 18,544 randomly selected age-matched patients without ED (1:4 ratio). The association between ED and hip fracture risk was estimated using a Cox proportional hazard regression model. During the follow-up period, 59 (1.27%) patients in the ED group and 140 (0.75%) patients in the non-ED group developed hip fracture. After adjusting for covariates, the overall incidence of hip fracture was 3.74-times higher in the ED group than in the non-ED group (2.03 vs. 0.50 per 1000 person-years, respectively). The difference in the overall incidence of hip fracture was largest during the 3-year follow-up period (hazard ratio = 7.85; 95% confidence interval = 2.94–20.96; P <0.0001). To the best of our knowledge, this nationwide population-based study is the first to investigate the relationship between ED and subsequent hip fracture in an Asian population. The results showed that ED patients had a higher risk of developing hip fracture. Patients with ED, particularly those aged 40–59 years, should undergo bone mineral density examinations as early as possible and should take measures to reduce the risk of falls.
Collapse
|
14
|
Cawthon PM, Shahnazari M, Orwoll ES, Lane NE. Osteoporosis in men: findings from the Osteoporotic Fractures in Men Study (MrOS). Ther Adv Musculoskelet Dis 2016; 8:15-27. [PMID: 26834847 DOI: 10.1177/1759720x15621227] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
The lifespan of men is increasing and this is associated with an increased prevalence of osteoporosis in men. Osteoporosis increases the risk of bone fracture. Fractures are associated with increased disability and mortality, and public health problems. We review here the study of osteoporosis in men as obtained from a longitudinal cohort of community-based older men, the Osteoporotic Fractures in Men Study (MrOS).
Collapse
Affiliation(s)
| | - Mohammad Shahnazari
- Northern California Institute for Research and Education, San Francisco, CA, USA
| | - Eric S Orwoll
- Oregon Health & Science University, Portland, OR, USA
| | - Nancy E Lane
- UC Davis Health System, 4625 2nd Avenue, Suite 2006, Sacramento, CA 95817, USA
| |
Collapse
|
15
|
Modulation and predictors of periprosthetic bone mineral density following total knee arthroplasty. BIOMED RESEARCH INTERNATIONAL 2015; 2015:418168. [PMID: 25793194 PMCID: PMC4352471 DOI: 10.1155/2015/418168] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/07/2014] [Revised: 10/21/2014] [Accepted: 10/30/2014] [Indexed: 11/17/2022]
Abstract
Total knee arthroplasty (TKA) leads to a loss of periprosthetic bone mineral density (BMD). Great importance is attached to the prevention of periprosthetic bone loss with a view to ensuring a long service life of the prosthesis. In order to provide appropriate recommendations for preventive movement therapy measures to combat peri-implant bone loss, it is necessary to know the predictors of periprosthetic BMD. The aim of this study was (1) to determine the change of periprosthetic BMD of the femur and tibia and (2) to analyse the effects of different predictors on periprosthetic BMD. Twenty-three patients with primary TKA were evaluated 10 days and 3 months postoperatively. The data analysis comprised (1) the change in periprosthetic BMD from pretest to posttest and (2) the correlations between BMD and the variables isometric maximum voluntary force, lean mass, physical activity (step count), and BMI using multiple linear regression and structural equation modelling (SEM). BMD of the distal femur was significantly reduced by 19.7% (P = 0.008) 3 months after surgery, while no changes were found in BMD of the tibia. The results of SEM demonstrate that 55% of the BMD variance was explained by the model (χ2 = 0.002; df = 1; P = 0.96; χ2/df = 0.002; RMSEA < 0.01; TLI = 1.5; CFI = 1.0). A significant direct effect was only evidenced by the variable lean mass (β = 0.38; b = 0.15; SE = 0.07; C.R. = 2.0; P = 0.046). It can be assumed that a large muscle mass with accompanying distribution of high mechanical load in the bones can contribute to local changes of periprosthetic BMD. Concrete recommendations for preventing peri-implant bone loss therefore include exercises which have the aim of maintaining or building up muscle mass.
Collapse
|
16
|
Abstract
Osteoporosis is a skeletal disease characterized by decreased bone mass and microarchitectural changes in bone tissue that increase the susceptibility to fracture. Secondary osteoporosis is loosely defined as low bone mineral density or increased risk of fragility fracture caused by any factor other than aging or postmenopausal status. The purpose of this review is to discuss the current understanding of the pathophysiology and contribution to fracture risk of many of the more common causes of secondary osteoporosis, as well as diagnostic considerations, outlined by organ system. While not comprehensive, included are a wide array of diseases, conditions, and medications that have been associated with bone loss and susceptibility to fractures. The hope is to highlight the importance to the general clinician of screening for and treating the osteoporosis in these patients, so to limit the resultant increased morbidity associated with fractures.
Collapse
Affiliation(s)
- Gregory R Emkey
- Pennsylvania Regional Center for Arthritis & Osteoporosis Research, 1200 Broadcasting Road, Suite 200, Wyomissing, PA 19610, USA.
| | - Sol Epstein
- Mt Sinai School of Medicine, I Gustave Levy Place New York, New York, NY, USA
| |
Collapse
|
17
|
Gebara MA, Shea MLO, Lipsey KL, Teitelbaum SL, Civitelli R, Müller DJ, Reynolds CF, Mulsant BH, Lenze EJ. Depression, antidepressants, and bone health in older adults: a systematic review. J Am Geriatr Soc 2014; 62:1434-41. [PMID: 25039259 DOI: 10.1111/jgs.12945] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVES To examine the association between depression, antidepressant use, and bone health in older adults and the implications for treatment. DESIGN Systematic review. SETTING All studies that measured depression or antidepressant exposure and bone mineral density (BMD). PARTICIPANTS Adults aged 60 and older. MEASUREMENTS Age, site of BMD measurement using dual-energy X-ray absorptiometry (DXA), measure of depression or depressive symptoms, association between BMD changes, and depression or antidepressant use. RESULTS Nineteen observational studies met the final inclusion criteria; no experimental studies were found. Several cross-sectional and longitudinal studies found that depression or depressive symptoms were associated with a decrease in BMD. Few studies and only two longitudinal studies addressed the association between serotonin reuptake inhibitor (SRI) antidepressant use and a decrease in BMD and they had conflicting results. CONCLUSION Depression and depressive symptoms are associated with low bone mass and accelerated bone loss in older adults; putative mechanisms underlying this relationship are discussed. There is insufficient evidence that SRI antidepressants adversely affect bone health. Thus, a change in current recommendations for the use of antidepressants in older adults is not justified at the present time. Given the high public health significance of this question, more studies are required to determine whether (and in whom) antidepressants may be deleterious for bone health.
Collapse
Affiliation(s)
- Marie Anne Gebara
- Department of Psychiatry, School of Medicine, Washington University, St. Louis, Missouri
| | | | | | | | | | | | | | | | | |
Collapse
|
18
|
Abstract
Osteoporosis and related fractures disproportionately impact patients with advanced age, those with the frailty phenotype, and those with multiple comorbidities. Recent studies report a changing incidence in fracture type among the oldest old throughout the world, a finding not satisfactorily explained by advances in treatment of lifestyle factors. A growing recognition of the importance of muscle and bone interaction is leading to improved understanding of the underlying biochemical pathways linking them and new therapeutic targets. New models of care for frail older populations, particularly after hip fracture, are being developed but have been challenged to identify appropriate outcomes to target. An appreciation for the relationship between age-related comorbidities, fracture risk, and competing mortality risk is essential for practitioners caring for the oldest-old population.
Collapse
Affiliation(s)
- Cathleen S Colón-Emeric
- Duke University Medical Center and the Durham VA Geriatrics Research Education and Clinical Center, 508 Fulton St. GRECC 182, Durham, NC, 27705, USA,
| |
Collapse
|
19
|
Malik P, Gasser RW, Moncayo RC, Kandler C, Koudouovoh-Tripp P, Giesinger J, Sperner-Unterweger B. Bone mineral density and bone metabolism in patients with major depressive disorder without somatic comorbidities. Prog Neuropsychopharmacol Biol Psychiatry 2013; 44:58-63. [PMID: 23380173 DOI: 10.1016/j.pnpbp.2013.01.019] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2012] [Revised: 01/25/2013] [Accepted: 01/27/2013] [Indexed: 10/27/2022]
Abstract
BACKGROUND Major depressive disorder (MDD) has been linked with accelerated bone loss leading to the development of low bone mineral density (BMD). Several mechanisms have been discussed as causative factors, e.g. lifestyle, selective serotonin reuptake inhibitor (SSRI) intake, or the influence of proinflammatory cytokines. METHODS In a cross-sectional study of in-patients with a current episode of MDD, without somatic comorbidities, we determined various parameters of bone metabolism, inflammatory parameters and parameters of depression. BMD was measured by dual x-ray absorptiometry. RESULTS Of 50 patients, only one had low BMD in any of the measure sites. Body mass index (BMI) correlated positively with Z-scores. 83.3% of the examined patients had elevated osteoprotegerin (OPG) levels. SSRI intake did not have an effect on BMD. BMD in the femoral neck was significantly lower in smokers. We also found a positive correlation between the level of physical activity and osteocalcin levels. CONCLUSIONS In our sample, young to middle-aged, somatically healthy, and acutely depressed patients with a history of MDD showed no reduction of BMD. This could be due to compensatory mechanisms, as suggested by elevated OPG levels. Physical activity and high BMI could also have served as protective factors. Still, as patients with MDD often suffer from comorbidities or take medication with a negative effect on bone, this population should be appreciated as a high-risk group for the development of osteopenia and osteoporosis.
Collapse
Affiliation(s)
- P Malik
- Department of Biological Psychiatry, Medical University, Anichstrasse 35, 6020 Innsbruck, Austria.
| | | | | | | | | | | | | |
Collapse
|
20
|
Shea MLO, Garfield LD, Teitelbaum S, Civitelli R, Mulsant BH, Reynolds CF, Dixon D, Doré P, Lenze EJ. Serotonin-norepinephrine reuptake inhibitor therapy in late-life depression is associated with increased marker of bone resorption. Osteoporos Int 2013; 24:1741-9. [PMID: 23358607 PMCID: PMC4066460 DOI: 10.1007/s00198-012-2170-z] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2012] [Accepted: 09/25/2012] [Indexed: 12/12/2022]
Abstract
UNLABELLED Antidepressants are associated with bone loss and fractures in older adults. We treated depressed older adults with an antidepressant and examined its effects on bone turnover by comparing blood samples before and after treatment. Bone resorption increased after antidepressant treatment, which may increase fracture risk. INTRODUCTION Antidepressants have been associated with increased bone loss and fractures in older adults in observational studies, but the mechanism is unclear. We examined the effects of a serotonin-norepinephrine reuptake inhibitor, venlafaxine, on biomarkers of bone turnover in a prospective treatment study of late-life depression. METHODS Seventy-six individuals aged 60 years and older with current major depressive disorder received a 12-week course of venlafaxine XR 150-300 mg daily. We measured serum C-terminal cross-linking telopeptide of type I collagen (β-CTX) and N-terminal propeptide of type I procollagen (P1NP), measures of bone resorption and formation, respectively, before and after treatment. We then analyzed the change in β-CTX and P1NP within each participant. Venlafaxine levels were measured at the end of the study. We assessed depression severity at baseline and remission status after treatment. RESULTS After 12 weeks of venlafaxine, β-CTX increased significantly, whereas P1NP did not significantly change. The increase in β-CTX was significant only in participants whose depression did not remit (increase by 10 % in non-remitters vs. 4 % in remitters). Change in β-CTX was not correlated with serum levels of venlafaxine or norvenlafaxine. CONCLUSION Our findings suggest that the primary effect of serotonergic antidepressants is to increase bone resorption. However, such an increase in bone resorption seemed to depend on whether or not participants' depression remitted. Our results are in agreement with prior observational studies reporting increased bone loss in older adults taking serotonergic antidepressants. These negative effects on bone homeostasis could potentially contribute to increased fracture risk in older adults.
Collapse
Affiliation(s)
- M L O Shea
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA.
| | | | | | | | | | | | | | | | | |
Collapse
|