NEWS: depression and osteoporosis

There have been various news items in recent years about this, and while we don't have specific links for you, we do want to just mention this topic. Recently-announced research results have established links between depression and osteoporosis, and between use of SSRI antidepressants and osteoporosis. What does this mean?

Well, to begin with, these studies have often used older women (60s or 70s) and not really focused on menopausal status or HRT use, so we don't really have that as a good variable. These studies are not about us, but we may be able to draw some useful information from them if we read carefully.

But most of the coverage we've seen (in medical media—not popular) has been fairly cautious about attributing one as the cause of the other. In other words, researchers are pointing out the need to view this as a correlation, not causation, until more about mechanisms is understood: these both may be the result of some common cause, not the cause of each other.

Now it's easy for us, with hormones on the brain (or not, as the case may be), to leap to the obvious-to-us conclusion that what is seen in both cases is simple estrogen deficiency. And so it may be. Certainly estrogen is involved in a lot of menopausal depressions, especially those that develop only with that lifestage (and falling hormone levels in the brain), and we know that falling estrogen is strongly tied with loss of bone density. And if we have depression and treat it with non-hormonal means, as most of the women it affects do, that means in today's pharmaceutical market it is likely that it will be treated with some variety of SSRI or close relation. So one could equally expect that a fair proportion of older female SSRI users would be likely to also have low estrogen levels and consequently be at relatively higher risk for losing density. That seems fairly reasonable—almost hardly worth the time to bother to do research to figure out.

But we have to remember that most medical research today is funded by and driven by the needs of the pharmaceutical companies—not our need for physiological information in greater depth of detail. Osteoporosis and depression drugs are some of the biggest moneymakers going, so it stands to reason that this area would be highly explored, looking to either establish existing products more firmly or to pick holes in competitors' products or to identify new product niches. If researchers can draw a line between depression and bones, they can exploit that while avoiding the whole HRT controversy and what is a fairly well-populated market (except for SERMs, which are themselves heavy into the bone niche).

And there is always the possibility that there is another mechanism than the obvious at work here—perhaps an enzyme missing or a genetic flaw that is expressed as a higher risk of both disorders coupled. And we can't neglect the aspect, raised by someone in our discussion list, that those with depression are not likely to be the best exercisers, even though exercise itself is a potent antidepressant. So there is indeed potential value to us in this research, limited though it is.

The takeaway we want to get to here, however, is that for women currently being treated for depression or for those using SSRIs as non-hormonal menopausal support, these findings probably do not reveal a higher-than-previously-anticipated level of risk or any particular reason to change your present approaches. Does it indicate a need to follow bone density more closely? Perhaps, if you're not doing so conscientiously right now. In fact, it would indeed be wise, absent any other research in this area, to consider menopausal-lifestage depressions as another indication of questionable hormone coverage that raises a bone-related red flag with an increased need to at least monitor and practice good prevention.

So this is another case of not-really-new news, but a reminder that many things in our bodies are interrelated and we need to keep those relationships in mind as we work on our health strategies for menopause. And, of course, not to be spooked by the headlines.