Smoking and Depression in Adolescent Girls May Lead to Higher Risk of Osteoporosis during Menopause

A new study indicates that depression and smoking in adolescent girls can be a cause for concern regarding postmenopausal osteoporosis.

The study shows that adult depression is commonly associated with osteoporosis and lower bone mineral density. Smoking may result in negative impact on bone health, and with adult smokers having a lower MBD compared to nonsmokers, it can likely increase lifetime fracture risk by as much as 31 percent.

According to a press release,  Osteoporosis is a costly health problem. The National Osteoporosis Foundation estimates that ten million Americans already have osteoporosis and an additional 34 million are at risk. In 2005, there were an estimated two million fractures attributed to osteoporosis costing an estimated $19 billion, and these numbers are expected to significantly increase.

Researchers from the Cincinnati Children's Hospital, University of Cincinnati College of Medicine and The Pennsylvania State University recruited 262 healthy girls between 11 and 19 years from a teen health clinic in a large children's hospital and it surrounding community to represent adolescents developing. They were then enrolled in four age cohorts (11, 13, 15, and 17 years). The goal was to have each age cohort reflect the number of smokers proportional to national statistics. The girls each attended three annual onsite visits. Phone interviews were conducted at three-month intervals between annual visits.

Bone accrual trajectories from ages 11 to 19 were estimated for total-body bone mineral content (TB BMC) and lumbar spine and total hip bone mineral density (BMD).

Investigators found that while smokers entered adolescence with equivalent levels of lumbar spine and total hip BMD, overall BMD accrual across adolescence was significantly lower as smoking frequency increased. Depressive symptoms showed a slightly different pattern, showing that girls with a higher level of symptoms had a slightly lower lumbar spine BMD.

"Adolescence is a crucial period of development that lays the foundation for women's health across the lifespan," said lead investigator Lorah D. Dorn, PhD, of Cincinnati Children's Hospital Medical Center and University of Cincinnati College of Medicine, Department of Pediatrics, Cincinnati, Ohio. "As much bone is accrued in the two years surrounding menarche as is lost in the last four decades of life.

"To our knowledge, our study is the first to test and demonstrate that smoking behavior and depressive symptoms in girls have a negative impact on bone accrual across adolescence. It may be premature to advocate screening for BMD in adolescents with depressive symptoms or those who smoke, but our study should be replicated to determine whether greater vigilance in monitoring bone mineral status is necessary," she said.