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From the Department of Psychiatry and Psychotherapy (K.G.K., W.G., S.R., U.S.), the Institute of Radiology (B.M.S., C.U.B.-K.), and the Institute of Clinical Chemistry (L.D.), Medical University of Schleswig-Holstein, Lübeck, Germany.
Address correspondence and reprint requests to Kai G. Kahl, MD, Klinik für Psychiatrie und Psychotherapie, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23538 Lübeck, Germany. E-mail: kaig.kahl{at}psychiatrie.uk-sh.de
Objective: Low bone mineral density has repeatedly been reported in patients with major depressive disorder (MDD), and MDD has been discussed as a risk factor for the development of osteoporosis. MDD in young adults often occurs in the context of borderline personality disorder (BPD), and both MDD and BPD have been associated with a dysregulation of the hypothalamic–pituitary–adrenal system and subsequent hypercortisolemia. To date, it is unclear whether comorbid BPD in depressed patients modulates the extent of bone mass reduction. Therefore, we examined bone density, markers of bone turnover, and proinflammatory cytokines in depressed patients with and without BPD. Patients with BPD alone and healthy women served as comparison groups.
Method: Twenty-four patients with MDD and 23 patients with comorbid MDD and BPD were included. Sixteen patients with BPD and 20 healthy women of similar body mass index served as the comparison group. BMD was assessed by means of dual-energy x-ray absorptiometry. Markers of bone turnover, endocrine and immune parameters were determined. For data analysis, the group of depressed patients without comorbid BPD was divided according to age into two groups (younger depressed patients with a mean age of 30 years and older patients with a mean age of 42.9 years).
Results: BMD at the lumbar spine was significantly reduced in a) depressed women with comorbid BPD (mean age, 28.6 years) and in b) older depressed patients without BPD (mean age, 42.9 years). Osteocalcin, a marker of osteoblastic activity, and crosslaps, a marker of bone loss, were significantly different between the study groups. Tumor necrosis factor-
was increased in depressed patients when compared with healthy women. Furthermore, TNF- was positively correlated with serum crosslaps, a marker for osteoclastic activity.
Conclusion: Depression is associated with reduced bone mass, in particular in patients with comorbid BPD. Possible factors contributing to BMD reduction include endocrine and immune alterations associated with either MDD or BPD. We conclude from our data that a history of MDD with and without comorbid BPD should be considered as a risk factor in clinical assessment instruments for the identification of persons prone to osteoporosis.
Key Words: borderline personality disorder • osteoporosis • major depressive disorder • TNF-
Abbreviations: BPD = borderline personality disorder; BMD = bone mineral density; AP = lumbar spine; RF = right femur; LF = left femur; FA = forearm; BMI = body mass index; HPAS = hypothalamic–pituitary–adrenal system; IGF-I = insulin-like growth factor-I; IL-6 = interleukin-6; MDD30 = patients with major depressive disorder and a mean age of 30 years; MDD43 = patients with major depressive disorder and a mean age of 43 years; MDD/BPD = patients with comorbid major depressive disorder and borderline personality disorder; OPG = osteoprotegerin; PTH = parathormone; TNF- = tumor-necrosis factor-.
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  Depression, Borderline Personality Disorder, and Osteoporosis? Journal Watch Psychiatry, December 4, 2006; 2006(1204): 2 - 2. [Full Text]
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