1
|
Xu H, Sun Z, Wang G, Li R. The Impact of Depression on Detrimental Changes in Bone Microstructure in Female Mice. Neuropsychiatr Dis Treat 2024; 20:1421-1433. [PMID: 39049938 PMCID: PMC11268775 DOI: 10.2147/ndt.s454865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Accepted: 07/02/2024] [Indexed: 07/27/2024] Open
Abstract
Background Several clinical studies have examined the connection between depression and bone loss, but the cause-and-effect relationship between the two conditions, especially in animal models, is not well-studied. Methods A total of 32 female mice were, randomly divided into control group (CON, n=19) and depression group (DEP, n=13). The mice in the DEP group were subjected to 21 consecutive days of restraint stress, following depressive-like behaviors were assessment. The femurs were collected using Micro-Computed Tomography (μCT) and histochemical staining. In parallel, levels of serotonin-related proteins in the brain were measured using Western blot analysis, and sex hormone profiles were determined through liquid chromatography-mass spectrometry/mass spectrometry (LC-MS/MS). Results The mice in the DEP group exhibited clear signs of depressive-like behaviors and an increase in serotonin transporter levels (t=-2.435, P< 0.05). In comparison to the CON mice, the DEP mice showed a decrease in bone mineral density (t =3.741, P< 0.05), bone surface area density (t =8.009, P<0.01), percent bone volume (t =4.293, P< 0.05), trabecular number (t =5.844, P<0.01), and connected density (t =11.000, P< 0.05). Additionally, there was an increase in trabecular separation (t =-7.436, P<0.01) in DEP mice. Furthermore, the DEP mice displayed a significant reduction in serum estrogen levels (t =4.340, P< 0.05) and changes in its metabolite (t =-3.325, P< 0.05), while the levels of androgens remained unchanged. Conclusion The restraint stress not only led to the development of depressive-like behaviors but also disrupted the estrogen metabolism pathway, resulting in damage to bone mass and microstructure in female mice. These findings suggest that stress-induced depression may pose a risk for bone loss in female mice by altering estrogen metabolism pathways.
Collapse
Affiliation(s)
- Hong Xu
- Beijing Key Laboratory of Mental Disorders, National Clinical Research Center for Mental Disorders & National Center for Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Zuoli Sun
- Beijing Key Laboratory of Mental Disorders, National Clinical Research Center for Mental Disorders & National Center for Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Gang Wang
- Beijing Key Laboratory of Mental Disorders, National Clinical Research Center for Mental Disorders & National Center for Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, People’s Republic of China
- Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, People’s Republic of China
| | - Rena Li
- Beijing Key Laboratory of Mental Disorders, National Clinical Research Center for Mental Disorders & National Center for Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, People’s Republic of China
| |
Collapse
|
2
|
de Filippis R, Mercurio M, Spina G, De Fazio P, Segura-Garcia C, Familiari F, Gasparini G, Galasso O. Antidepressants and Vertebral and Hip Risk Fracture: An Updated Systematic Review and Meta-Analysis. Healthcare (Basel) 2022; 10:healthcare10050803. [PMID: 35627940 PMCID: PMC9140335 DOI: 10.3390/healthcare10050803] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2022] [Revised: 04/14/2022] [Accepted: 04/23/2022] [Indexed: 12/10/2022] Open
Abstract
Although antidepressant drugs appear to play an active role in increasing fracture risk, their weight is still unclear. We conducted a PRISMA compliant systematic review and meta-analysis through PubMed/Scopus/Cochrane libraries and registered with PROSPERO (registration number CRD42021254006) to investigate the relationship between antidepressant drugs categories, including SSRIs, SNRIs, and TCAs, and the risk of hip and vertebral fractures. After screening 3122 items, we finally found 26 papers for qualitative analysis and 11 for quantitative synthesis. A total of 15,209,542 adult and elderly patients were identified, with a mean follow-up of 51 months and a major prevalence of women. We identified results largely for SSRIs, with only a small amount of data for SNRIs, TCAs, and NaSSA. No data were found among the most recent categories of antidepressants, such as vortioxetine and esketamine. All included studies reported hip fractures, while three of them also included vertebral fractures. Overall, we observed a significant effect of SSRIs on fracture risk with a mean effect of 0.98 (95% CI = 0.75–1.20). This meta-analysis reveals that the use of SSRIs increases the risk of fractures. Clinicians’ awareness in antidepressant prescription should optimize their potential while reducing this risk.
Collapse
Affiliation(s)
- Renato de Filippis
- Psychiatry Unit, Department of Health Sciences, University Magna Graecia of Catanzaro, 88100 Catanzaro, Italy; (R.d.F.); (P.D.F.)
| | - Michele Mercurio
- Department of Orthopaedic and Trauma Surgery, “Mater Domini” University Hospital, V.le Europa (loc. Germaneto), “Magna Græcia” University, 88100 Catanzaro, Italy; (G.S.); (F.F.); (G.G.); (O.G.)
- Correspondence: ; Tel.: +39-0961-3647122
| | - Giovanna Spina
- Department of Orthopaedic and Trauma Surgery, “Mater Domini” University Hospital, V.le Europa (loc. Germaneto), “Magna Græcia” University, 88100 Catanzaro, Italy; (G.S.); (F.F.); (G.G.); (O.G.)
| | - Pasquale De Fazio
- Psychiatry Unit, Department of Health Sciences, University Magna Graecia of Catanzaro, 88100 Catanzaro, Italy; (R.d.F.); (P.D.F.)
| | - Cristina Segura-Garcia
- Psychiatry Unit, Department of Medical and Surgical Sciences, University Magna Graecia of Catanzaro, 88100 Catanzaro, Italy;
| | - Filippo Familiari
- Department of Orthopaedic and Trauma Surgery, “Mater Domini” University Hospital, V.le Europa (loc. Germaneto), “Magna Græcia” University, 88100 Catanzaro, Italy; (G.S.); (F.F.); (G.G.); (O.G.)
| | - Giorgio Gasparini
- Department of Orthopaedic and Trauma Surgery, “Mater Domini” University Hospital, V.le Europa (loc. Germaneto), “Magna Græcia” University, 88100 Catanzaro, Italy; (G.S.); (F.F.); (G.G.); (O.G.)
| | - Olimpio Galasso
- Department of Orthopaedic and Trauma Surgery, “Mater Domini” University Hospital, V.le Europa (loc. Germaneto), “Magna Græcia” University, 88100 Catanzaro, Italy; (G.S.); (F.F.); (G.G.); (O.G.)
| |
Collapse
|
3
|
He B, Lyu Q, Yin L, Zhang M, Quan Z, Ou Y. Depression and Osteoporosis: A Mendelian Randomization Study. Calcif Tissue Int 2021; 109:675-684. [PMID: 34259888 PMCID: PMC8531056 DOI: 10.1007/s00223-021-00886-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 06/29/2021] [Indexed: 12/15/2022]
Abstract
Observational studies suggest a link between depression and osteoporosis, but these may be subject to confounding and reverse causality. In this two-sample Mendelian randomization analysis, we included the large meta-analysis of genome-wide association studies for depression among 807,553 individuals (246,363 cases and 561,190 controls) of European descent, the large meta-analysis to identify genetic variants associated with femoral neck bone mineral density (FN-BMD), forearm BMD (FA-BMD) and lumbar spine BMD (LS-BMD) among 53,236 individuals of European ancestry, and the GWAS summary data of heel BMD (HE-BMD) and fracture among 426,824 individuals of European ancestry. The results revealed that genetic predisposition towards depression showed no causal effect on FA-BMD (beta-estimate: 0.091, 95% confidence interval [CI] - 0.088 to 0.269, SE:0.091, P value = 0.320), FN-BMD (beta-estimate: 0.066, 95% CI - 0.016 to 0.148, SE:0.042, P value = 0.113), LS-BMD (beta-estimate: 0.074, 95% CI - 0.029 to 0.177, SE:0.052, P value = 0.159), HE-BMD (beta-estimate: 0.009, 95% CI - 0.043 to 0.061, SE:0.027, P value = 0.727), or fracture (beta-estimate: 0.008, 95% CI - 0.071 to 0.087, SE:0.041, P value = 0.844). These results were also confirmed by multiple sensitivity analyses. Contrary to the findings of observational studies, our results do not reveal a causal role of depression in osteoporosis or fracture.
Collapse
Affiliation(s)
- Bin He
- Department of Orthopedics, The First Affiliated Hospital of Chongqing Medical University, No. 1 Yi Xue Yuan Road, Yuzhong District, Chongqing, 400016, China.
| | - Qiong Lyu
- Department of General Practice, The First Affiliated Hospital of Chongqing Medical University, No. 1 Yi Xue Yuan Road, Yuzhong District, Chongqing, 400016, China
| | - Lifeng Yin
- Department of Orthopedics, The First Affiliated Hospital of Chongqing Medical University, No. 1 Yi Xue Yuan Road, Yuzhong District, Chongqing, 400016, China
| | - Muzi Zhang
- Department of Orthopedics, The First Affiliated Hospital of Chongqing Medical University, No. 1 Yi Xue Yuan Road, Yuzhong District, Chongqing, 400016, China
| | - Zhengxue Quan
- Department of Orthopedics, The First Affiliated Hospital of Chongqing Medical University, No. 1 Yi Xue Yuan Road, Yuzhong District, Chongqing, 400016, China
| | - Yunsheng Ou
- Department of Orthopedics, The First Affiliated Hospital of Chongqing Medical University, No. 1 Yi Xue Yuan Road, Yuzhong District, Chongqing, 400016, China
| |
Collapse
|
4
|
Madel MB, Elefteriou F. Mechanisms Supporting the Use of Beta-Blockers for the Management of Breast Cancer Bone Metastasis. Cancers (Basel) 2021; 13:cancers13122887. [PMID: 34207620 PMCID: PMC8228198 DOI: 10.3390/cancers13122887] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2021] [Revised: 06/06/2021] [Accepted: 06/08/2021] [Indexed: 12/22/2022] Open
Abstract
Simple Summary Bone represents the most common site of metastasis for breast cancer and the establishment and growth of metastatic cancer cells within the skeleton significantly reduces the quality of life of patients and their survival. The interplay between sympathetic nerves and bone cells, and its influence on the process of breast cancer bone metastasis is increasingly being recognized. Several mechanisms, all dependent on β-adrenergic receptor signaling in stromal bone cells, were shown to promote the establishment of disseminated cancer cells into the skeleton. This review provides a summary of these mechanisms in support of the therapeutic potential of β-blockers for the early management of breast cancer metastasis. Abstract The skeleton is heavily innervated by sympathetic nerves and represents a common site for breast cancer metastases, the latter being the main cause of morbidity and mortality in breast cancer patients. Progression and recurrence of breast cancer, as well as decreased overall survival in breast cancer patients, are associated with chronic stress, a condition known to stimulate sympathetic nerve outflow. Preclinical studies have demonstrated that sympathetic stimulation of β-adrenergic receptors in osteoblasts increases bone vascular density, adhesion of metastatic cancer cells to blood vessels, and their colonization of the bone microenvironment, whereas β-blockade prevented these events in mice with high endogenous sympathetic activity. These findings in preclinical models, along with clinical data from breast cancer patients receiving β-blockers, support the pathophysiological role of excess sympathetic nervous system activity in the formation of bone metastases, and the potential of commonly used, safe, and low-cost β-blockers as adjuvant therapy to improve the prognosis of bone metastases.
Collapse
Affiliation(s)
| | - Florent Elefteriou
- Department of Orthopedic Surgery, Baylor College of Medicine, Houston, TX 77030, USA;
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX 77030, USA
- Correspondence:
| |
Collapse
|
5
|
Yang F, Liu Y, Chen S, Dai Z, Yang D, Gao D, Shao J, Wang Y, Wang T, Zhang Z, Zhang L, Lu WW, Li Y, Wang L. A GABAergic neural circuit in the ventromedial hypothalamus mediates chronic stress-induced bone loss. J Clin Invest 2021; 130:6539-6554. [PMID: 32910804 DOI: 10.1172/jci136105] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Accepted: 08/26/2020] [Indexed: 12/25/2022] Open
Abstract
Homeostasis of bone metabolism is regulated by the central nervous system, and mood disorders such as anxiety are associated with bone metabolism abnormalities, yet our understanding of the central neural circuits regulating bone metabolism is limited. Here, we demonstrate that chronic stress in crewmembers resulted in decreased bone density and elevated anxiety in an isolated habitat mimicking a space station. We then used a mouse model to demonstrate that GABAergic neural circuitry in the ventromedial hypothalamus (VMH) mediates chronic stress-induced bone loss. We show that GABAergic inputs in the dorsomedial VMH arise from a specific group of somatostatin neurons in the posterior region of the bed nucleus of the stria terminalis, which is indispensable for stress-induced bone loss and is able to trigger bone loss in the absence of stressors. In addition, the sympathetic system and glutamatergic neurons in the nucleus tractus solitarius were employed to regulate stress-induced bone loss. Our study has therefore identified the central neural mechanism by which chronic stress-induced mood disorders, such as anxiety, influence bone metabolism.
Collapse
Affiliation(s)
- Fan Yang
- Brain Cognition and Brain Disease Institute, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences (CAS).,CAS Key Laboratory of Brain Connectome and Manipulation.,Guangdong Provincial Key Laboratory of Brain Connectome and Behavior.,Shenzhen-Hong Kong Institute of Brain Science-Shenzhen Fundamental Research Institutions, Shenzhen, China.,University of Chinese Academy of Sciences, Beijing, China
| | - Yunhui Liu
- Brain Cognition and Brain Disease Institute, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences (CAS).,CAS Key Laboratory of Brain Connectome and Manipulation.,Guangdong Provincial Key Laboratory of Brain Connectome and Behavior.,Shenzhen-Hong Kong Institute of Brain Science-Shenzhen Fundamental Research Institutions, Shenzhen, China.,University of Chinese Academy of Sciences, Beijing, China
| | - Shanping Chen
- Brain Cognition and Brain Disease Institute, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences (CAS).,CAS Key Laboratory of Brain Connectome and Manipulation.,Guangdong Provincial Key Laboratory of Brain Connectome and Behavior.,Shenzhen-Hong Kong Institute of Brain Science-Shenzhen Fundamental Research Institutions, Shenzhen, China.,University of Chinese Academy of Sciences, Beijing, China
| | - Zhongquan Dai
- State Key Laboratory of Space Medicine Fundamentals and Application, China Astronaut Research and Training Center, Beijing, China
| | - Dazhi Yang
- Department of Orthopedics, Union Shenzhen Hospital, Huazhong University of Science and Technology, Shenzhen, China
| | - Dashuang Gao
- Brain Cognition and Brain Disease Institute, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences (CAS).,CAS Key Laboratory of Brain Connectome and Manipulation.,Guangdong Provincial Key Laboratory of Brain Connectome and Behavior.,Shenzhen-Hong Kong Institute of Brain Science-Shenzhen Fundamental Research Institutions, Shenzhen, China.,University of Chinese Academy of Sciences, Beijing, China
| | - Jie Shao
- Brain Cognition and Brain Disease Institute, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences (CAS).,CAS Key Laboratory of Brain Connectome and Manipulation.,Guangdong Provincial Key Laboratory of Brain Connectome and Behavior.,Shenzhen-Hong Kong Institute of Brain Science-Shenzhen Fundamental Research Institutions, Shenzhen, China.,University of Chinese Academy of Sciences, Beijing, China
| | - Yuyao Wang
- Brain Cognition and Brain Disease Institute, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences (CAS).,CAS Key Laboratory of Brain Connectome and Manipulation.,Guangdong Provincial Key Laboratory of Brain Connectome and Behavior.,Shenzhen-Hong Kong Institute of Brain Science-Shenzhen Fundamental Research Institutions, Shenzhen, China
| | - Ting Wang
- Brain Cognition and Brain Disease Institute, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences (CAS).,CAS Key Laboratory of Brain Connectome and Manipulation.,Guangdong Provincial Key Laboratory of Brain Connectome and Behavior.,Shenzhen-Hong Kong Institute of Brain Science-Shenzhen Fundamental Research Institutions, Shenzhen, China
| | - Zhijian Zhang
- Center for Brain Science, Key Laboratory of Magnetic Resonance in Biological Systems and State Key Laboratory of Magnetic Resonance and Atomic and Molecular Physics, Wuhan Institute of Physics and Mathematics, CAS, Wuhan, China.,Center for Excellence in Brain Science and Intelligence Technology, CAS, Shanghai, China
| | - Lu Zhang
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Hong Kong, China
| | - William W Lu
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Hong Kong, China
| | - Yinghui Li
- State Key Laboratory of Space Medicine Fundamentals and Application, China Astronaut Research and Training Center, Beijing, China
| | - Liping Wang
- Brain Cognition and Brain Disease Institute, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences (CAS).,CAS Key Laboratory of Brain Connectome and Manipulation.,Guangdong Provincial Key Laboratory of Brain Connectome and Behavior.,Shenzhen-Hong Kong Institute of Brain Science-Shenzhen Fundamental Research Institutions, Shenzhen, China.,University of Chinese Academy of Sciences, Beijing, China
| |
Collapse
|
6
|
Power C, Duffy R, Mahon J, McCarroll K, Lawlor BA. Bones of Contention: A Comprehensive Literature Review of Non-SSRI Antidepressant Use and Bone Health. J Geriatr Psychiatry Neurol 2020; 33:340-352. [PMID: 31665962 DOI: 10.1177/0891988719882091] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Osteoporotic fractures are associated with major morbidity and mortality, particularly among older age groups. In recent decades, selective serotonin reuptake inhibitors (SSRI) antidepressants have been linked to reduced bone mineral density and increased risk of fragility fracture. However, up to one-third of antidepressant prescriptions are for classes other than SSRIs. Older patients, who are particularly vulnerable to osteoporosis and its clinical and psychosocial consequences, may be prescribed non-SSRI antidepressants preferentially because of increasing awareness of the risks SSRIs pose to bone health. However, to date, the skeletal effects of non-SSRI antidepressants have not been comprehensively reviewed. In this article, we collate and review the available data and discuss the findings. Based on the current literature, we tentatively suggest that tricyclic antidepressants may increase the risk of fracture via mechanisms other than a direct effect on bone mineral density. The risk is apparently confined to current users only and is greatest in the earliest stage of treatment, diminishing thereafter. There is, as yet, insufficient data to conclusively determine the effects of other antidepressant classes on bone. Judicious prescribing of antidepressants among higher risk groups necessitates a thorough review of the individual's risk factors for osteoporosis as well as attention to their falls risk. Further longitudinal, rigorously controlled studies are needed to answer some of the remaining questions on the effects of non-SSRI antidepressants on bone and the mechanisms by which they are exerted.
Collapse
Affiliation(s)
- Clodagh Power
- Mercer's Institute for Successful Ageing, 58024St James's Hospital, Dublin, Ireland
| | - Richard Duffy
- Jonathan Swift Clinic, 58024St James's Hospital, Dublin, Ireland
| | - James Mahon
- Mercer's Institute for Successful Ageing, 58024St James's Hospital, Dublin, Ireland
| | - Kevin McCarroll
- Mercer's Institute for Successful Ageing, 58024St James's Hospital, Dublin, Ireland
| | - Brian A Lawlor
- Mercer's Institute for Successful Ageing, 58024St James's Hospital, Dublin, Ireland
| |
Collapse
|
7
|
Effects of Early Life Stress on Bone Homeostasis in Mice and Humans. Int J Mol Sci 2020; 21:ijms21186634. [PMID: 32927845 PMCID: PMC7556040 DOI: 10.3390/ijms21186634] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2020] [Revised: 08/27/2020] [Accepted: 09/05/2020] [Indexed: 11/16/2022] Open
Abstract
Bone pathology is frequent in stressed individuals. A comprehensive examination of mechanisms linking life stress, depression and disturbed bone homeostasis is missing. In this translational study, mice exposed to early life stress (MSUS) were examined for bone microarchitecture (μCT), metabolism (qPCR/ELISA), and neuronal stress mediator expression (qPCR) and compared with a sample of depressive patients with or without early life stress by analyzing bone mineral density (BMD) (DXA) and metabolic changes in serum (osteocalcin, PINP, CTX-I). MSUS mice showed a significant decrease in NGF, NPYR1, VIPR1 and TACR1 expression, higher innervation density in bone, and increased serum levels of CTX-I, suggesting a milieu in favor of catabolic bone turnover. MSUS mice had a significantly lower body weight compared to control mice, and this caused minor effects on bone microarchitecture. Depressive patients with experiences of childhood neglect also showed a catabolic pattern. A significant reduction in BMD was observed in depressive patients with childhood abuse and stressful life events during childhood. Therefore, future studies on prevention and treatment strategies for both mental and bone disease should consider early life stress as a risk factor for bone pathologies.
Collapse
|
8
|
Affiliation(s)
- J Zhou
- Department of Orthopaedic Surgery, Tianjin Medical University General Hospital, Heping District, Tianjin, 300052, China
| | - Y Xue
- Department of Orthopaedic Surgery, Tianjin Medical University General Hospital, Heping District, Tianjin, 300052, China.
| |
Collapse
|
9
|
Williams LJ, Stuart AL, Berk M, Brennan-Olsen SL, Hodge JM, Cowdery S, Chandrasekaran V, Pasco JA. Bone health in bipolar disorder: a study protocol for a case-control study in Australia. BMJ Open 2020; 10:e032821. [PMID: 32051309 PMCID: PMC7044863 DOI: 10.1136/bmjopen-2019-032821] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
INTRODUCTION Little is known about the bone health of adults with bipolar disorder, aside from evidence purporting bone deficits among individuals with other mental illnesses, or those taking medications commonly used in bipolar disorder. In this paper, we present the methodology of a case-control study which aims to examine the role of bipolar disorder as a risk factor for bone fragility. METHODS AND ANALYSIS Men and women with bipolar disorder (~200 cases) will be recruited and compared with participants with no history of bipolar disorder (~1500 controls) from the Geelong Osteoporosis Study. Both cases and controls will be drawn from the Barwon Statistical Division, south-eastern Australia. The Structured Clinical Interview for DSM-IV-TR Research Version, Non-patient edition is the primary diagnostic instrument, and psychiatric symptomatology will be assessed using validated rating scales. Demographic information and detailed lifestyle data and medical history will be collected via comprehensive questionnaires. Participants will undergo dual energy X-ray absorptiometry scans and other clinical measures to determine bone and body composition. Blood samples will be provided after an overnight fast and stored for batch analysis. ETHICS AND DISSEMINATION Ethics approval has been granted from Barwon Health Research Ethics Committee. Participation in the study is voluntary. The study findings will be disseminated via peer-reviewed publications, conference presentations and reports to the funding body.
Collapse
Affiliation(s)
- Lana J Williams
- School of Medicine, Deakin University, Geelong, Victoria, Australia
- Barwon Health, Geelong, Victoria, Australia
| | - Amanda L Stuart
- School of Medicine, Deakin University, Geelong, Victoria, Australia
| | - Michael Berk
- School of Medicine, Deakin University, Geelong, Victoria, Australia
- Department of Psychiatry, The University of Melbourne, Parkville, Victoria, Australia
- Florey Institute of Neuroscience and Mental Health, Parkville, Victoria, Australia
- Orygen, The National Centre of Excellence in Youth Mental Health, Centre for Youth Mental Health, Parkville, Victoria, Australia
| | - Sharon L Brennan-Olsen
- Department of Medicine-Western Health, The University of Melbourne, St Albans, Victoria, Australia
| | - Jason M Hodge
- School of Medicine, Deakin University, Geelong, Victoria, Australia
- Barwon Health, Geelong, Victoria, Australia
- Geelong Centre for Emerging Infectious Diseases, Geelong, Victoria, Australia
| | | | | | - Julie A Pasco
- School of Medicine, Deakin University, Geelong, Victoria, Australia
- Barwon Health, Geelong, Victoria, Australia
- Department of Medicine-Western Health, The University of Melbourne, St Albans, Victoria, Australia
| |
Collapse
|
10
|
Kim SY, Min C, Park B, Kim M, Choi HG. Evaluation of the increased risk of spine fracture in patients with mood disorder compared with matched controls: a longitudinal follow-up study using a national sample cohort in Korea. BMJ Open 2019; 9:e027581. [PMID: 31784429 PMCID: PMC6924799 DOI: 10.1136/bmjopen-2018-027581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To evaluate the risk of spine fracture in patients with mood disorder using a nationwide cohort. DESIGN A longitudinal follow-up study. SETTING Claims data for the population ≥20 years of age were collected from 2002 to 2013 for the Korean National Health Insurance Service-National Sample Cohort. PARTICIPANTS A total of 60 140 individuals with mood disorder were matched with 240 560 individuals (control group) for age, sex, income, region of residence and osteoporosis. INTERVENTIONS In both the mood disorder and control groups, the history of spine fracture was evaluated. The International Classification of Diseases 10th Revision codes for mood disorder (F31-F39) and spine fracture (S220 and S320) were included. PRIMARY AND SECONDARY OUTCOME MEASURES The univariable and multivariable HRs and 95% CIs of spine fracture for patients with mood disorder were analysed using a stratified Cox proportional hazards model. Subgroup analyses were conducted according to the history of osteoporosis, age and sex. RESULTS Approximately 3.3% (2011/60 140) of patients in the mood disorder group and 2.8% (6795/240 560) of individuals in the control group had spine fracture (p<0.001). The mood disorder group demonstrated a higher adjusted HR for spine fracture than the control group (multivariable HR=1.10, 95% CI 1.04 to 1.15, p<0.001). The participants without osteoporosis showed a higher HR of mood disorder for spine fracture than the control participants (multivariable HR=1.25, 95% CI 1.14 to 1.37, p<0.001). According to age and sex, this result was consistent in subgroups of women aged 20-39 and 40-59 years and men aged ≥60 years. CONCLUSION The risk of spine fracture was increased in patients with mood disorder. The potential risk of spine fracture needs to be evaluated when managing patients with mood disorder.
Collapse
Affiliation(s)
- So Young Kim
- Department of Otorhinolaryngology-Head & Neck Surgery, CHA Bundang Medical Center, CHA University, Seongnam, South Korea
| | - Chanyang Min
- Hallym Data Science Laboratory, Hallym University College of Medicine, Chuncheon, South Korea
| | - Bumjung Park
- Otorhinolaryngology-Head and Neck Surgery, Hallym University College of Medicine, Chuncheon, South Korea
| | - Miyoung Kim
- Laboratory Medicine, Hallym University College of Medicine, Chuncheon, South Korea
| | - Hyo Geun Choi
- Hallym Data Science Laboratory, Hallym University College of Medicine, Chuncheon, South Korea
- Otorhinolaryngology-Head and Neck Surgery, Hallym University College of Medicine, Chuncheon, South Korea
| |
Collapse
|
11
|
Aslam H, Holloway-Kew KL, Mohebbi M, Jacka FN, Pasco JA. Association between dairy intake and fracture in an Australian-based cohort of women: a prospective study. BMJ Open 2019; 9:e031594. [PMID: 31753881 PMCID: PMC6887043 DOI: 10.1136/bmjopen-2019-031594] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVE Given the inconsistent evidence on dairy consumption and risk of fracture, we assessed the association between milk/total dairy consumption and major osteoporotic fracture (MOF) in women from the Geelong Osteoporosis Study (GOS). METHODS Women aged ≥50 years (n=833) were followed from baseline (1993-1997) to date of first fracture, death or 31 December 2017, whichever occurred first. Dairy consumption was assessed by self-report at baseline and the follow-up phases. MOFs (hip, forearm, clinical spine and proximal humerus) were confirmed radiologically. Multivariable-adjusted Cox proportional hazard models were used to determine associations between milk/total dairy (milk, cheese, yoghurt, ice cream) consumption and MOFs. Cross-sectional associations between milk/total dairy consumption and serum high-sensitivity C reactive protein (hsCRP), C-terminal telopeptide (CTx) and procollagen type 1 N-terminal propeptide (P1NP) at baseline were investigated using multivariable linear regression. RESULTS During follow-up (11 507 person-years), 206 women had an MOF. Consuming >500 mL/d of milk was not significantly associated with increased HR for MOF. Non-milk (1.56; 95% CI 0.99 to 2.46) drinkers and consumption of ≥800 g/d total dairy (1.70; 95% CI 0.99 to 2.93) had marginally higher HR for MOF compared with consuming <250 mL/d of milk and 200-399 g/d of total dairy, respectively. Milk consumption was inversely associated with serum hsCRP and CTx, but total dairy consumption was not associated with these serum markers. CONCLUSION Higher milk consumption did not increase the risk for MOF in older women. However, a trend for increased MOF was detected in zero milk and higher total dairy consuming women.
Collapse
Affiliation(s)
- Hajara Aslam
- School of Medicine, IMPACT SRC, Deakin University, Geelong, Victoria, Australia
| | - Kara L Holloway-Kew
- School of Medicine, IMPACT SRC, Deakin University, Geelong, Victoria, Australia
| | - Mohammadreza Mohebbi
- Faculty of Health,Biostatistics Unit, Deakin University, Burwood, Victoria, Australia
| | - Felice N Jacka
- School of Medicine, IMPACT SRC, Deakin University, Geelong, Victoria, Australia
- Centre for Adolescent Health, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- Black Dog Institute, Sydney, New South Wales, Australia
| | - Julie A Pasco
- School of Medicine, IMPACT SRC, Deakin University, Geelong, Victoria, Australia
- Department of Medicine, Western Campus, The University of Melbourne, St Albans, New South Wales, Australia
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- University Hospital Geelong, Barwon Health, Geelong, Victoria, Australia
| |
Collapse
|
12
|
Chandrasekaran V, Brennan-Olsen SL, Stuart AL, Pasco JA, Berk M, Hodge JM, Williams LJ. Bipolar disorder and bone health: A systematic review. J Affect Disord 2019; 249:262-269. [PMID: 30784723 DOI: 10.1016/j.jad.2019.02.013] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Revised: 01/24/2019] [Accepted: 02/05/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND Bipolar disorder is a chronic, episodic mental illness, affecting around 2.4% of the population worldwide. Psychological and/or physiological comorbidities are a common consequence, and osteoporosis is one such possible comorbidity. Thus, this systematic review aimed to collate, evaluate, and discuss the literature examining the link between bipolar disorder and bone health. METHODS We conducted an e-search of PubMed/OVID/MEDLINE, PsychINFO and CINAHL to identify studies that investigated associations between bipolar disorder and bone in adults aged ≥18. Two reviewers determined eligibility according to pre-determined criteria, and methodological quality was assessed using a previously published methodological scoring system. Due to heterogeneity, a best-evidence synthesis was performed. RESULTS Our search yielded 1409 articles, of which three (all cohorts) met predetermined criteria. The studies from Taiwan and the United States of America analysed administrative data, albeit spanning different years, and comprised a total of 344,497 participants. No studies investigating bone quantity or quality were identified. Bipolar disorder was associated with an increased risk of fracture (range 20-80%); and fracture-free survival time for those with bipolar disorder decreased substantially with advancing age, and for women (10-30% shorter than men). Fracture incidence per 1000 person years (py) was 21.4 and 10.8 in those with and without bipolar disorder, respectively. LIMITATIONS Limited data and marked methodological heterogeneity prevented the pooling of these data for a numerical synthesis. CONCLUSIONS Increased fracture risk was observed in individuals with bipolar disorder, independent of older age, sex, comorbidities and medication use. The operative mechanisms, risk and treatment factors warrant further enquiry.
Collapse
Affiliation(s)
- Vinoomika Chandrasekaran
- Deakin University, School of Medicine, IMPACT Strategic Research Centre, PO Box 281, Geelong, 3220 Australia.
| | - Sharon L Brennan-Olsen
- Department of Medicine-Western Health, The University of Melbourne, St Albans, Australia; Australian Institute for Musculoskeletal Science (AIMSS), The University of Melbourne and Western Health, St Albans, Australia..
| | - Amanda L Stuart
- Deakin University, School of Medicine, IMPACT Strategic Research Centre, PO Box 281, Geelong, 3220 Australia.
| | - Julie A Pasco
- Deakin University, School of Medicine, IMPACT Strategic Research Centre, PO Box 281, Geelong, 3220 Australia; Department of Medicine-Western Health, The University of Melbourne, St Albans, Australia; Australian Institute for Musculoskeletal Science (AIMSS), The University of Melbourne and Western Health, St Albans, Australia.; Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia; Barwon Health University Hospital, Geelong, Australia.
| | - Michael Berk
- Deakin University, School of Medicine, IMPACT Strategic Research Centre, PO Box 281, Geelong, 3220 Australia; Department of Psychiatry, University of Melbourne, Parkville, Australia; Florey Institute of Neuroscience and Mental Health, Parkville, Australia; Orygen the National Centre of Excellence in Youth Mental Health, Parkville, Australia.
| | - Jason M Hodge
- Deakin University, School of Medicine, IMPACT Strategic Research Centre, PO Box 281, Geelong, 3220 Australia; Barwon Health University Hospital, Geelong, Australia; Geelong Centre for Emerging Infectious Diseases, Geelong, Australia.
| | - Lana J Williams
- Deakin University, School of Medicine, IMPACT Strategic Research Centre, PO Box 281, Geelong, 3220 Australia.
| |
Collapse
|
13
|
Association between depression and the risk for fracture: a meta-analysis and systematic review. BMC Psychiatry 2018; 18:336. [PMID: 30333001 PMCID: PMC6192066 DOI: 10.1186/s12888-018-1909-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2018] [Accepted: 09/25/2018] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Several studies have suggested that depression is associated with an increased risk for fracture; however, the results are conflicting. This study aimed to conduct a meta-analysis of cohort studies assessing the association between depression and the risk for fracture. METHODS Relevant studies were identified by a search of Web of Science, PubMed, Embase, China National Knowledge Infrastructure and WanFang database to Feb 2018. Cohort studies on the relationship between depression and the risk for fracture in the general population were included in the meta-analysis. Data collection was in accordance with the Meta-analysis of Observational Studies in Epidemiology (MOOSE) guidelines, and the quality of the included studies was assessed using the Newcastle-Ottawa scale. Two independent investigators screened the abstracts and full texts of the studies, extracted data, and assessed the quality of the study. Either a fixed-effect or random-effects model was used to compute the pooled risk estimates when appropriate. RESULTS In total, 16 cohort studies with 25 independent reports that included 414,686 participants during a follow-up duration of 3-14 years were included in the analysis. The pooled hazard ratio (HR) for total fracture was 1.24 (95% confidence interval [CI]: 1.14-1.35; P < 0.001 for heterogeneity; random-effects model). In the subgroup analyses conducted in terms of study region, the pooled HR for the studies conducted in Europe was higher (HR: 1.76; 95% CI: 1.44-2.17; P = 0.792 for heterogeneity) than that in America and Asia, with a significant difference between the groups (P = 0.036). CONCLUSION The results of our meta-analysis suggest that depression is prospectively associated with a significantly increased risk for fracture, which may have substantial implications, both clinical and preventive.
Collapse
|
14
|
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
|
15
|
Yatham LN, Kennedy SH, Parikh SV, Schaffer A, Bond DJ, Frey BN, Sharma V, Goldstein BI, Rej S, Beaulieu S, Alda M, MacQueen G, Milev RV, Ravindran A, O'Donovan C, McIntosh D, Lam RW, Vazquez G, Kapczinski F, McIntyre RS, Kozicky J, Kanba S, Lafer B, Suppes T, Calabrese JR, Vieta E, Malhi G, Post RM, Berk M. Canadian Network for Mood and Anxiety Treatments (CANMAT) and International Society for Bipolar Disorders (ISBD) 2018 guidelines for the management of patients with bipolar disorder. Bipolar Disord 2018; 20:97-170. [PMID: 29536616 PMCID: PMC5947163 DOI: 10.1111/bdi.12609] [Citation(s) in RCA: 937] [Impact Index Per Article: 156.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Accepted: 12/21/2017] [Indexed: 12/14/2022]
Abstract
The Canadian Network for Mood and Anxiety Treatments (CANMAT) previously published treatment guidelines for bipolar disorder in 2005, along with international commentaries and subsequent updates in 2007, 2009, and 2013. The last two updates were published in collaboration with the International Society for Bipolar Disorders (ISBD). These 2018 CANMAT and ISBD Bipolar Treatment Guidelines represent the significant advances in the field since the last full edition was published in 2005, including updates to diagnosis and management as well as new research into pharmacological and psychological treatments. These advances have been translated into clear and easy to use recommendations for first, second, and third- line treatments, with consideration given to levels of evidence for efficacy, clinical support based on experience, and consensus ratings of safety, tolerability, and treatment-emergent switch risk. New to these guidelines, hierarchical rankings were created for first and second- line treatments recommended for acute mania, acute depression, and maintenance treatment in bipolar I disorder. Created by considering the impact of each treatment across all phases of illness, this hierarchy will further assist clinicians in making evidence-based treatment decisions. Lithium, quetiapine, divalproex, asenapine, aripiprazole, paliperidone, risperidone, and cariprazine alone or in combination are recommended as first-line treatments for acute mania. First-line options for bipolar I depression include quetiapine, lurasidone plus lithium or divalproex, lithium, lamotrigine, lurasidone, or adjunctive lamotrigine. While medications that have been shown to be effective for the acute phase should generally be continued for the maintenance phase in bipolar I disorder, there are some exceptions (such as with antidepressants); and available data suggest that lithium, quetiapine, divalproex, lamotrigine, asenapine, and aripiprazole monotherapy or combination treatments should be considered first-line for those initiating or switching treatment during the maintenance phase. In addition to addressing issues in bipolar I disorder, these guidelines also provide an overview of, and recommendations for, clinical management of bipolar II disorder, as well as advice on specific populations, such as women at various stages of the reproductive cycle, children and adolescents, and older adults. There are also discussions on the impact of specific psychiatric and medical comorbidities such as substance use, anxiety, and metabolic disorders. Finally, an overview of issues related to safety and monitoring is provided. The CANMAT and ISBD groups hope that these guidelines become a valuable tool for practitioners across the globe.
Collapse
Affiliation(s)
- Lakshmi N Yatham
- Department of PsychiatryUniversity of British ColumbiaVancouverBCCanada
| | | | - Sagar V Parikh
- Department of PsychiatryUniversity of MichiganAnn ArborMIUSA
| | - Ayal Schaffer
- Department of PsychiatryUniversity of TorontoTorontoONCanada
| | - David J Bond
- Department of PsychiatryUniversity of MinnesotaMinneapolisMNUSA
| | - Benicio N Frey
- Department of Psychiatry and Behavioural NeurosciencesMcMaster UniversityHamiltonONCanada
| | - Verinder Sharma
- Departments of Psychiatry and Obstetrics & GynaecologyWestern UniversityLondonONCanada
| | | | - Soham Rej
- Department of PsychiatryMcGill UniversityMontrealQCCanada
| | - Serge Beaulieu
- Department of PsychiatryMcGill UniversityMontrealQCCanada
| | - Martin Alda
- Department of PsychiatryDalhousie UniversityHalifaxNSCanada
| | - Glenda MacQueen
- Department of PsychiatryUniversity of CalgaryCalgaryABCanada
| | - Roumen V Milev
- Departments of Psychiatry and PsychologyQueen's UniversityKingstonONCanada
| | - Arun Ravindran
- Department of PsychiatryUniversity of TorontoTorontoONCanada
| | | | - Diane McIntosh
- Department of PsychiatryUniversity of British ColumbiaVancouverBCCanada
| | - Raymond W Lam
- Department of PsychiatryUniversity of British ColumbiaVancouverBCCanada
| | - Gustavo Vazquez
- Departments of Psychiatry and PsychologyQueen's UniversityKingstonONCanada
| | - Flavio Kapczinski
- Department of Psychiatry and Behavioural NeurosciencesMcMaster UniversityHamiltonONCanada
| | | | - Jan Kozicky
- School of Population and Public HealthUniversity of British ColumbiaVancouverBCCanada
| | | | - Beny Lafer
- Department of PsychiatryUniversity of Sao PauloSao PauloBrazil
| | - Trisha Suppes
- Bipolar and Depression Research ProgramVA Palo AltoDepartment of Psychiatry & Behavioral Sciences Stanford UniversityStanfordCAUSA
| | - Joseph R Calabrese
- Department of PsychiatryUniversity Hospitals Case Medical CenterCase Western Reserve UniversityClevelandOHUSA
| | - Eduard Vieta
- Bipolar UnitInstitute of NeuroscienceHospital ClinicUniversity of BarcelonaIDIBAPS, CIBERSAMBarcelonaCataloniaSpain
| | - Gin Malhi
- Department of PsychiatryUniversity of SydneySydneyNSWAustralia
| | - Robert M Post
- Department of PsychiatryGeorge Washington UniversityWashingtonDCUSA
| | - Michael Berk
- Deakin UniveristyIMPACT Strategic Research CentreSchool of Medicine, Barwon HealthGeelongVic.Australia
| |
Collapse
|
16
|
Jhon M, Yoo T, Lee JY, Kim SY, Kim JM, Shin IS, Williams L, Berk M, Yoon JS, Kim SW. Gender-specific risk factors for low bone mineral density in patients taking antipsychotics for psychosis. Hum Psychopharmacol 2018; 33. [PMID: 29315805 DOI: 10.1002/hup.2648] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Revised: 11/29/2017] [Accepted: 11/30/2017] [Indexed: 12/19/2022]
Abstract
OBJECTIVE This study examined clinical and gender-specific risk factors for low bone mineral density (BMD) in adult patients with psychotic disorders. METHODS The study included 285 community-dwelling patients with psychotic disorders. Dual-energy X-ray absorptiometry was used to measure BMD. Clinical characteristics associated with low BMD were identified with logistic regression analysis in total population and each gender. RESULTS Fifty-eight (20.4%) subjects had low BMD. Low BMD was more common in men and in patients with low body mass indices (BMIs), as well as in those with shorter treatment durations, those on Medicaid, and patients using serotonergic antidepressants. Logistic regression analysis revealed that low BMD was negatively associated with BMI and treatment duration and positively with gender (male) and serotonergic antidepressants use in the overall population. In men, low BMD was associated with treatment duration and BMI; in women, low BMD was associated with BMI, prolactin level, vitamin D, and serotonergic antidepressant use. CONCLUSION Managing the risk factors associated with low BMD among patients with psychotic disorder should be done gender-specifically. Psychotropic agents should be prescribed mindful of their effects on bone, as use of these medications is a modifiable risk factor for osteoporosis in women with psychotic disorders.
Collapse
Affiliation(s)
- Min Jhon
- Department of Psychiatry, Chonnam National University Medical School, Gwangju, South Korea
| | - Taeyoung Yoo
- Department of Psychiatry, Chonnam National University Medical School, Gwangju, South Korea
| | - Ju-Yeon Lee
- Department of Psychiatry, Chonnam National University Medical School, Gwangju, South Korea.,Gwangju Mental Health Commission, Gwangju, South Korea
| | - Seon-Young Kim
- Department of Psychiatry, Chonnam National University Medical School, Gwangju, South Korea
| | - Jae-Min Kim
- Department of Psychiatry, Chonnam National University Medical School, Gwangju, South Korea
| | - Il-Seon Shin
- Department of Psychiatry, Chonnam National University Medical School, Gwangju, South Korea
| | - Lana Williams
- Deakin University, IMPACT Strategic Research Centre, School of Medicine, Geelong, Victoria, Australia
| | - Michael Berk
- Deakin University, IMPACT Strategic Research Centre, School of Medicine, Geelong, Victoria, Australia.,Orygen, The National Centre of Excellence in Youth Mental Health, Florey Institute for Neuroscience and Mental Health and the Department of Psychiatry, The University of Melbourne, Melbourne, Australia
| | - Jin-Sang Yoon
- Department of Psychiatry, Chonnam National University Medical School, Gwangju, South Korea
| | - Sung-Wan Kim
- Department of Psychiatry, Chonnam National University Medical School, Gwangju, South Korea.,Gwangju Mental Health Commission, Gwangju, South Korea
| |
Collapse
|
17
|
Lo C, Sung FC, Mou CH, Lin TC, Tseng CH, Tzeng YL. Population study evaluating fracture risk among patients with chronic osteomyelitis. PLoS One 2017; 12:e0189743. [PMID: 29267371 PMCID: PMC5739410 DOI: 10.1371/journal.pone.0189743] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Accepted: 11/30/2017] [Indexed: 11/18/2022] Open
Abstract
Background Studies investigating the fracture risk in patients with chronic osteomyelitis (COM) limited to case reports. This study evaluated the association between COM and subsequent fracture risk using population-based data. Methods A subset claims data of the Taiwan National Health Insurance was used to identify 7,147 patients with COM newly diagnosed in 1999–2005 without fracture history and 28,588 general population controls, frequency matched by sex, age and diagnosis date. The incident fractures was measured by the end of 2013. Results The incidence density of fracture was 1.94-fold greater in the COM cohort than in controls (21.5 vs. 11.1 per 1000 person-years), with the adjusted hazard ratio (HR) of 1.81 (95% CI: 1.67–1.95) for COM patients compared to controls after controlling for sex, age, and comorbidities of diabetes, osteoporosis, depression and end-stage renal disease in Cox proportional hazards regression. The fracture risk increased with age and women were at greater risk than men. The fracture incidence increased substantially in those with osteoporosis, 40.2 per 1000 person-years in COM patients. Site specific analysis showed a higher portion of incident fractures for lower limbs, 52.7% in COM cohort and 46.3% in controls. Conclusion Findings in this 15-year follow-up observation support our hypothesis that patients with COM are at an elevated risk of subsequent fracture. COM patients and the elderly deserve adequate consultation and awareness for fracture prevention.
Collapse
Affiliation(s)
- Chyi Lo
- School of Nursing, College of Health Care, China Medical University, Taichung, Taiwan
- Department of Nursing, China Medical University Hospital, Taichung, Taiwan
| | - Fung-Chang Sung
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan
- Department of Health Services Administration, China Medical University, Taichung, Taiwan
| | - Chih-Hsin Mou
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan
| | - Tzu-Chieh Lin
- Division of Traumatology, Emergency Department, Taichung Veterans General Hospital, Taichung, Taiwan
- Department of Public Health, China Medical University, Taichung, Taiwan
| | - Chun-Huang Tseng
- Department of Neurology, China Medical University Hospital, Taichung, Taiwan
| | - Ya-Ling Tzeng
- School of Nursing, College of Health Care, China Medical University, Taichung, Taiwan
- Department of Nursing, China Medical University Hospital, Taichung, Taiwan
- * E-mail:
| |
Collapse
|
18
|
Imai T, Tanaka S, Kawakami K, Miyazaki T, Hagino H, Shiraki M. Health state utility values and patient-reported outcomes before and after vertebral and non-vertebral fractures in an osteoporosis clinical trial. Osteoporos Int 2017; 28:1893-1901. [PMID: 28265719 DOI: 10.1007/s00198-017-3966-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2016] [Accepted: 02/09/2017] [Indexed: 10/20/2022]
Abstract
UNLABELLED We assessed the health state utility value (HSUV) reductions associated with vertebral fractures using data collected in the Japanese Osteoporosis Intervention Trial-03 (JOINT-03). Our analysis revealed that assessment of HSUVs after morphometric vertebral fracture is important to capture the burden of vertebral fractures. INTRODUCTION Evaluation of the HSUV after fracture is important to calculate the quality-adjusted life years (QALYs) of osteoporosis patients, which is essential information in the context of health economic evaluation. METHODS JOINT-03 study patients were aged ≥65 years and treated with risedronate and vitamin K2 or risedronate alone. Radiographic information and patient-reported outcomes measured by EQ-5D and a visual analogue scale (VAS) were assessed at registration and followed up after 6, 12, and 24 months. According to differences among the dates of these assessments and the radiographic information, we classified the follow-up HSUVs calculated based on EQ-5D results into before or after fracture categories regardless of clinical symptoms. RESULTS Among 2922 follow-up HSUVs, 201 HSUVs were categorized as HSUVs that were observed after incident vertebral fractures on X-ray films. The median time from the detection of an incident vertebral fracture until the EQ-5D assessment was 53 days (25th percentile, 0 day; 75th percentile, 357 days). The impact of incident vertebral fractures on HSUVs was quantified as -0.03. Among the five health profile domains on the EQ-5D, an incident vertebral fracture had significant effects on anxiety/depression, self-care, and usual activities. CONCLUSIONS The results suggest that incident morphometric vertebral fracture was associated with impairment of the HSUV for patients with osteoporosis not only immediately but also several months after the fracture.
Collapse
Affiliation(s)
- T Imai
- Department of Pharmacoepidemiology, Graduate School of Medicine and Public Health, Kyoto University, Kyoto, 606-8501, Japan
| | - S Tanaka
- Department of Pharmacoepidemiology, Graduate School of Medicine and Public Health, Kyoto University, Kyoto, 606-8501, Japan
| | - K Kawakami
- Department of Pharmacoepidemiology, Graduate School of Medicine and Public Health, Kyoto University, Kyoto, 606-8501, Japan.
| | - T Miyazaki
- Public Health Research Foundation, Tokyo, Japan
| | - H Hagino
- School of Health Science, Tottori University Faculty of Medicine, Tottori, Japan
| | - M Shiraki
- Department of Internal Medicine, Research Institute and Practice for Involutional Diseases, Nagano, Japan
| | | |
Collapse
|
19
|
Wippert PM, Rector M, Kuhn G, Wuertz-Kozak K. Stress and Alterations in Bones: An Interdisciplinary Perspective. Front Endocrinol (Lausanne) 2017; 8:96. [PMID: 28507534 PMCID: PMC5410657 DOI: 10.3389/fendo.2017.00096] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Accepted: 04/18/2017] [Indexed: 11/29/2022] Open
Abstract
Decades of research have demonstrated that physical stress (PS) stimulates bone remodeling and affects bone structure and function through complex mechanotransduction mechanisms. Recent research has laid ground to the hypothesis that mental stress (MS) also influences bone biology, eventually leading to osteoporosis and increased bone fracture risk. These effects are likely exerted by modulation of hypothalamic-pituitary-adrenal axis activity, resulting in an altered release of growth hormones, glucocorticoids and cytokines, as demonstrated in human and animal studies. Furthermore, molecular cross talk between mental and PS is thought to exist, with either synergistic or preventative effects on bone disease progression depending on the characteristics of the applied stressor. This mini review will explain the emerging concept of MS as an important player in bone adaptation and its potential cross talk with PS by summarizing the current state of knowledge, highlighting newly evolving notions (such as intergenerational transmission of stress and its epigenetic modifications affecting bone) and proposing new research directions.
Collapse
Affiliation(s)
- Pia-Maria Wippert
- Department of Health Sciences, Institute of Sociology of Health and Physical Activity, University of Potsdam, Potsdam, Germany
- Department of Health Sciences and Technology, Institute for Biomechanics, ETH Zurich, Zurich, Switzerland
- *Correspondence: Pia-Maria Wippert,
| | - Michael Rector
- Department of Health Sciences, Institute of Sociology of Health and Physical Activity, University of Potsdam, Potsdam, Germany
| | - Gisela Kuhn
- Department of Health Sciences and Technology, Institute for Biomechanics, ETH Zurich, Zurich, Switzerland
| | - Karin Wuertz-Kozak
- Department of Health Sciences, Institute of Sociology of Health and Physical Activity, University of Potsdam, Potsdam, Germany
- Department of Health Sciences and Technology, Institute for Biomechanics, ETH Zurich, Zurich, Switzerland
- Schön Klinik München Harlaching, Munich, Germany
- Spine Center, Academic Teaching Hospital and Spine Research Institute, Paracelsus Private Medical University Salzburg, Salzburg, Austria
- Competence Center for Applied Biotechnology and Molecular Medicine (CABMM), University of Zurich, Zurich, Switzerland
| |
Collapse
|