Evaluation of bone mineral density among patients with depression in penang Island, Malaysia
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Date
2009
Authors
Kurmanji, Jaafer Mosadek
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Abstract
Introduction: Depression a mental illness described by sadness, loss of interest, troubled
sleep and appetite and low energy levels. It is also correlating with some alterations in
endogenous hormonal levels as well as poor socio-behaviors, resulting in modification in a
bone metabolism and bone remodeling process. Studies have shown that there is a significant
association between depression and low Bone Mineral Density (BMD) and this prompt the
effort to evaluate this reiationship in a Malaysian population in Penang, Malaysia.
Methodology: The study employed a cohort sample of four hundred and twenty participants,
140 had depressive illnesses obtained from psychiatric clinics in Penang General Hospital
and Penang Adventist Hospital, and 280 were non-depressed subjects as controls from the
community, with their age ranged from 25-70 years old. BMD assessed at the heel's
calcaneus by measure the quantitative ultrasound derivatives T-and Z-scores using Furuno
Ultrasound bone densitometry CM200 for the whole sample. Result: The percentage of
participant who had low BMD as defined by quantitative ultrasound derivatives T -scores ( < -
I) was significantly higher in patients with depressive illnesses (P < O.OOI) with relative risk
of I. 72 (95% CI 1.40-2.II ), and significant in male only group with relative risk 3.0 folds
(95% CI 1.99 to 4.68) and female only group with relative risk 1.37 fold (95% CI 1.08 to
1.74) in females. After adjusting the confounding variables by applying binary logistic
regression, found association of low BMD with depression in group of both sexes at odd
ratio 2.76 (95% CI 1.61-4.73) and P-value (<0.001) and showed significant association of
depression with low BMD in males group only with P-value (<0.001) and odd ration 19.82
(95% CI 5.64-69.63). The mean ultrasound derivatives T-score in the depressed patients was
significantly lower than in control group in both sexes while the mean quantitative
ultrasound derivatives Z-score was significantly lower in depressed group than in healthy
group among males only. ANOV A test showed no significant effect of race, employment,
education level, religion and other life styles on the BMD. Subjects bad regular exercise
habit showed had significantly high mean Z-score comparing to those who had not with Pvalue
(0.020). This study showed significant correlation ofBMD in term ofT- and Z-scores
with the times of exercise doing per week with P-value (0.002). Spearman test significant
negative correlation of Z-score with the number of symptoms suffered by the depressed
patients P-value (0.036). No correlation recorded between Z-score and the duration of
depression in the depressed patients. ANOV A showed no significant difference in the mean
Z-score between the depressed patients using different antidepressant medications.
Conclusion: Depression may be associated with low BMD represented by quantitative
ultrasound derivatives T -score (<-I) in a Malaysian population. This study concluded that
males are highly affected by depression than females regarding bone loss. The study
estimated the evidence of protective effect of exercise on the BMD. It showed a significant
relationship of the number of symptoms with bone loss. This study reported no advantage of
use antidepressant medication over the other toward the BMD. The study recommends
further attention from the psychiatrist with regard to the incidence of osteoporosis or low
bone mineral density when dealing with their depressed patients.