The role of stress-induced cortisol in the relationship between depression and decreased bone mineral density

Background: This study was designed to test the hypothesis that cortisol mediates the relationship between bone density and depression in postmenopausal women. Methods. Nineteen women aged 52-79 who bad been assessed for bone mineral density by dual-energy x-ray absorptiometer (DEXA) were evaluated for depression and anxiety. Diurnal and stress-induced measures of salivary cortisol were obtained during the following week and at a laboratory session involving a speech task. Results. Nine volunteers reported depression while 10 were never depressed. Ever depressed women bad significantly lower total lumbar and right femur DEAA Z scores than never depressed (t(17) = 2.5, p = .019 and t(17) = 2.06, p = .05, respectively). Ever depressed women demonstrated a significant increase in salivary cortisol (area under the curve (AUC) 27.83, SD = 37.64) compared to never depressed women (AUC= -13.34, SD = 19.55) (t(17) = -3.041, p = .007) during a psychological challenge. There were significant inverse relationships between salivary cortisol AUC values and bone density Z scores at every measured bone site. Mediation analyses suggest that 51-67% of the association between depression and bone density could be attributed to stress-induced changes in cortisol. Conclusions. Cortisol hypesecretion in response to stress may, in pail, explain the impact of depression on bone density in post-menopausal women.