Table 2.

Case-control studies of depression or depressive symptoms and bone mineral density

First Author	Year	Location	Sample size	Source of participantsa	Measure of exposureb	Duration of exposure	Measure of BMDc	Matching and/or statistical adjustment	Main findings
Schweiger [6]	1994	Germany	137	Inpatient clinic, community controls, age: 40–95 yrs	MDC	Current	Lumbar spine SE-QCT	Adjusted for age	MDD assoc w/lower BMD compared to controls
Halbreich [8]	1995	USA	68	Inpatient clinic, age: 20–66 yrs	Psych Dx	Current	Lumbar spine & femoral neck DPA	Matched on age and sex	Psych Dxd assoc w/lower BMD compared to age and sex-matched normative BMD data
Michelson [11]	1996	USA	48	Community volunteers (only women), mean age: 41 yrs	SCID	Past or current	Lumbar spine, hip & radius DEXA	Matched on 5-year age strata, BMI, menopausal status, race	MDD assoc w/lower BMD compared to controls
Amsterdam [20]	1998	USA	11	Outpatient clinic, community controls, age: 27–53 yrs	Psych Dx	<1 yr to 25 yrs	Lumbar spine DEXA	None	No assoc btwn MDD & BMD
Vrkljan [14]	2001	Croatia	48	Inpatient clinic, community controls, age: 29–45 yrs	Psych Dx	Current	Unknown	None	Duration of depression therapy assoc w/lower BMD
Kavuncu [21]	2002	Turkey	84	Inpatient clinic, community controls (only women), mean age: 36 yrs	Psych Dx HDRS	Current	Lumbar spine & hip DEXA	Matched on age and BMI	No assoc btwn MDD & BMD No assoc btwn DepSx severity & BMD
Yazici [16]	2003	Turkey	40	Outpatient clinic, community controls only women), mean age: 31 yrs	SCAN	Current	Lumbar spine & hip DEXA	Matched on age, BMI, calcium intake, physical activity, social class	MDD assoc w/lower BMD
Yazici[25]	2005	Turkey	65	Outpatient clinic, community controls (only women), mean age: 45 yrs	Psych Dx HDRS	Current	Lumbar spine & femoral neck DEXA	Matched on age, BMI, age of menarche, number of pregnancies	No assoc btwn MDD & BMD
Kahl [10]	2005	Germany	58	Borderline PDd clinic, community controls (only women), mean age: 27 yrs	SCID	Current and Lifetime	Lumbar spine, femur & forearm DEXA	Matched on age and sex	MDD+borderline PDd assoc w/lower BMD vs. borderline PD alone MDD + borderline PD assoc w/lower BMD vs. neither
Altindag [17]	2007	Turkey	77	Outpatient clinic, community controls (only women), age: 26–56 yrs	Psych Dx HDRS	Current ≥ 3 months	Lumbar spine & femoral neck DEXA	Matched on age, BMI, age of menarche and parity	MDD assoc w/lower BMD

^aUnless otherwise stated, studies include both men and women. Mean age of study participants is given if age range was unavailable

^bDiagnostic measures of depression (MDD or MDE): MDC Munich diagnostic checklist, Psych Dx psychiatrist diagnosis of major depressive disorder or major depressive episode. SCID structured clinical interview for DSM. SCAN structured clinical assessment for neuropsychiatry. Non-diagnostic measures of depressive symptoms (DepSx): HDRS Hamilton depression rating scale.

^cSE-QCT Single-energy quantitative computerized tomography, DPA dual-photon absorptiometry, DEXA dual energy x-ray absorptiometry

^dPsych Dx includes major depressive disorder, schizophrenia, schizoaffective disorder, mania or adjustment disorder