摘要
重度抑郁症(MDD)是一种普遍的慢性疾病,不断增加全球疾病和残疾的负担。许多相关的合并症的发病率和死亡率的双向影响增加了这种疾病的复杂性。在近些年来,骨质疏松症越来越被认定为重度抑郁症显著的并发症。这一参考文献的叙述性综述评论目的在于总结关键的流行病学研究并讨论假设机制的相互作用。流行病学研究已经反复证明骨折的共患病率增加和在重度抑郁症(MDD)中骨矿物质密度(BMD)的减少。这种相互作用的病理生理机制无疑是复杂的、多因素的,而且从临床前和临床模型中提出的假定途径有着不同层次的证据。从概念上讲,抑郁症的机制可能会影响骨骼 代谢的情况可以分为生物、行为、医源性和合并症等相关因素。生物因素包括炎症-情绪通路、下丘脑-垂体-肾上腺(HPA)轴失调、代谢紊乱、和5-羟色胺对骨细胞的直接和间接影响。行为因素包括生活方式的选择,尤其是典型的抑郁症患者,如烟草使用的增加或锻炼的减少。精神病学与医学并存病和常见的骨质疏松症与重度抑郁症(MDD)有普遍性,都应该得到同样的重视。体育活动的推广、补充维生素D和MDD患者常规骨密度筛查等简单的干预措施,可能会对这两个条件产生改善的结果。对这种潜在机制更好的认识可能会在MDD人群中有助于洞察到对骨质疏松和骨折新的预防和治疗策略。
关键词: 骨质疏松,骨密度(BMD),骨折,重度抑郁症(MDD)、抗抑郁药、细胞因子、维生素D、5-羟色胺。
Current Molecular Medicine
Title:Depression and Disturbed Bone Metabolism: A Narrative Review of the Epidemiological Findings and Postulated Mechanisms
Volume: 16 Issue: 2
Author(s): J.D. Rosenblat, J.M. Gregory, A.F. Carvalho and R.S. McIntyre
Affiliation:
关键词: 骨质疏松,骨密度(BMD),骨折,重度抑郁症(MDD)、抗抑郁药、细胞因子、维生素D、5-羟色胺。
摘要: Major depressive disorder (MDD) is a pervasive chronic condition that contributes substantially to the global burden of disease and disability. Adding to the complexity of this disorder are numerous associated medical comorbidities with a bidirectional impact on morbidity and mortality. In recent years, osteoporosis has been increasingly identified as a significant comorbidity of MDD. This narrative review examines the literature to summarize key epidemiological studies and discuss postulated mechanisms of interaction. Epidemiological studies have repeatedly shown an increased co-prevalence of fractures and decreased bone mineral density (BMD) in MDD. The pathophysiological mechanism underlying this interaction is undoubtedly complex and multifactorial, and proposed pathways have varying levels of evidence from preclinical and clinical models. Conceptually, the mechanisms by which depression might influence bone metabolism can be categorized into biological, behavioral, iatrogenic, and comorbidity-related factors. Biological factors include the inflammatory-mood pathway, hypothalamic-pituitary-adrenal (HPA) axis dysregulation, metabolic dysfunction, and serotonin’s direct and indirect effects on bone cells. Behavioral factors incorporate lifestyle choices typical in depressed patients, such as increased tobacco use or limited exercise. The prominent iatrogenic factor is the independent effects of anti-depressants on bone metabolism. Psychiatric and medical comorbidities common to both osteoporosis and MDD are also important to consider. Physical activity promotion, vitamin D supplementation, and routine BMD screening of MDD patients are simple interventions that might lead to improved outcomes for both conditions. An improved understanding of the underlying mechanisms may yield insights into novel prevention and treatment strategies to target osteoporosis and fractures in the MDD population.
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Cite this article as:
J.D. Rosenblat, J.M. Gregory, A.F. Carvalho and R.S. McIntyre , Depression and Disturbed Bone Metabolism: A Narrative Review of the Epidemiological Findings and Postulated Mechanisms, Current Molecular Medicine 2016; 16 (2) . https://dx.doi.org/10.2174/1566524016666160126144303
DOI https://dx.doi.org/10.2174/1566524016666160126144303 |
Print ISSN 1566-5240 |
Publisher Name Bentham Science Publisher |
Online ISSN 1875-5666 |
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