Osteoporosis in depression: Which patients are at risk?
Psychotropics increase fracture risk; depression compounds poor bone health
Table 3
Reducing osteoporosis risk: Recommendations for patients age >50
| Assess dietary calcium (at least 1,200 mg/d) and dietary vitamin D intake (800 to 1,000 IU/d) |
| Exercise regularly, especially weight-bearing and muscle-strengthening activities (eg, walking, jogging, stair climbing, weight-lifting) |
| Stop using tobacco |
| Avoid heavy alcohol use |
| Implement fall precautions such as rubber-soled shoes when walking, handrails for staircases, and removing tripping hazards, including loose rugs |
| Source: Reference 1 |
CASE CONTINUED: High risk can be lowered
Ms. P’s family history, antidepressant use, smoking, and low dietary calcium intake associated with lactose intolerance increase her risk for osteoporosis. Her history of anorexia nervosa also increases her risk if she experiences amenorrhea. You advise her that she can ameliorate some of these factors by quitting smoking, exercising regularly, and taking calcium and vitamin D supplements. You refer her to her primary care physician because she wishes to undergo bone mineral density screening.
Related resources
- National Osteoporosis Foundation. Clinician‘s guide to prevention and treatment of osteoporosis. www.nof.org/professionals/Clinicians_Guide.htm.
- World Health Organization Fracture Risk Assessment Tool. Calculates a 10-year probability of hip fracture using demographic data, family history, comorbid medication and predisposing medical conditions. www.shef.ac.uk/FRAX.
Drug brand names
- Alendronate • Fosamax
- Carbamazepine • Tegretol
- Clonazepam • Klonopin
- Diazepam • Valium
- Fluoxetine • Prozac
- Haloperidol • Haldol
- Lamotrigine • Lamictal
- Lithium • Eskalith, Lithobid
- Lorazepam • Ativan
- Oxcarbazepine • Trileptal
- Prednisone • Deltasone, Meticorten
- Raloxifene • Evista
- Risperidone • Risperdal
- Teriparatide • Forteo
- Valproate • Depakote
Disclosure
The authors report no financial relationship with any company whose products are mentioned in this article or with manufacturers of competing products.
