Depresija kao uzrok osteoporoza u fertilnih žena

master's thesis

• Title (english): Depression as a cause of osteoporosis in fertile women
• Author: Mara Boban
• Mentor: Milan Vrkljan (mentor)
• Committee member: Neven Ljubičić (predsjednik povjerenstva)
• Committee member: Jasenka Markeljević (član povjerenstva)
• Committee member: Milan Vrkljan (član povjerenstva)
• Granter: University of Zagreb; School of Medicine; (Department of Internal Medicine); Zagreb
• Defense date and country: 2016-07-15, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences; Internal Medicine

Abstract

Depresija i osteoporoza dvije su kronične bolesti sa značajnom i rastućom prevalencijom, smrtnošću i smanjenom kvalitetom života. Većina znanstvenih dokaza podupire teoriju o depresiji kao uzročniku osteoporoze. Međutim, zbog nedostatne svijesti o toj poveznici, fertilne žene bez drugih rizičnih čimbenika pod većim su rizikom za razvoj neprepoznate osteoporoze. Neki od predloženih patofizioloških mehanizama u podlozi su: prejaka aktivacija osi hipotalamus-hipofiza-nadbubrežna žlijezda s hiperkortizolizmom, pojačan simpatički tonus i izlučivanje proupalnih citokina, smanjenje hormona rasta i gonadalnih hormona te životni stil. Serotoninsko djelovanje je i kataboličko i anaboličko, ovisno o podrijetlu, a djelovanje leptina još je uvijek nedovoljno razjašnjeno. Ne smije se zanemariti ni učinak selektivnih inhibitora ponovne pohrane serotonina i tricikličkih antidepresiva jer ih neke studije povezuju sa smanjenjem mineralne gustoće kostiju. Budući da se radi o izuzetno važnom zdravstvenom i društvenom problemu, veliki depresivni poremećaj bi se službeno trebao uvrstiti na popis rizičnih čimbenika za razvoj osteoporoze u premenopauzalnih žena. Daljnja istraživanja su potrebna kako bi se dodatno pojasnili mehanizmi povezanosti i postavili novi terapijski ciljevi. Pritom je bitno ujednačiti kriterije odabira ispitanika i izbjeći čimbenike zabune koji su dosada otežavali shvaćanje ove tematike. S druge strane, liječnici bi u svom svakodnevnom radu trebali posvetiti veću pozornost ranom otkrivanju depresije te provjeri mineralne gustoće kostiju denzitometrijom kod rizičnih pojedinaca.

Abstract (english)

Depression and osteoporosis are two chronic diseases with significant and growing prevalence, mortality and reduced quality of life. Most studies confirm the causative relationship between depression and osteoporosis. However, due to insufficient recognition of depression as a risk factor, fertile women without other contributing factors may be under increased risk of developing unrecognized osteoporosis. The proposed underlying pathophysiological mechanisms associating depression and osteoporosis include: increased activation of the hypothalamic-pituitary-adrenocortical axis with hypercortisolism, increased sympathetic tone and proinflammatory cytokine production, hypogonadism and growth hormone deficiency as well as the lifestyle. Serotonin has both anabolic and catabolic effect, depending on its origin, while leptin influence on bone remodeling remains unclear. Moreover, effect of selective serotonin reuptake inhibitors and tricyclic antidepressants on bone mineral density have also been proposed as negative contributing factors. Considering proportions and impact of this medical and social problem, major depressive disorder should be officially recognized as a risk factor for osteoporosis in premeopausal women. Further studies are warranted to determine underlying mechanisms which would reveal new therapeutic targets. However, researchers must take into account numerous potential confounders when planning studies in order to aviod unclear and limited conclusions. On the other hand, physicians in their everyday practice should focus more on early detection of depression and bone densitometry in suspected patients.

• Keywords: depresija; osteoporoza; mineralna gustoća kostiju; denzitometrija; selektivni inhibitori ponovne pohrane serotonina; triciklički antidepresivi
• Keywords (english): depression; osteoporosis; bone mineral density; densitometry; selective serotonin reuptake inhibitors; tricyclic antidepressants
• Language: croatian
• URN:NBN: urn:nbn:hr:105:303029
• Study programme: Title: Medicine; Study programme type: university; Study level: integrated undergraduate and graduate; Academic / professional title: doktor/doktorica medicine (doktor/doktorica medicine)
• Type of resource: Text
• File origin: Born digital
• Access conditions: Open access
• Created on: 2017-06-26 11:41:44