Association of Depressive Symptoms and Anxiety With Bone Mass and Density in Ever-Smoking and Never-Smoking Adolescent Girls

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Abstract
Objectives To examine (1) the association of depressive and anxiety symptoms with bone mass and density in adolescent girls and (2) to examine this association in subgroups of those who have ever or never smoked. Design Prospective study using baseline reports. Setting Urban teenage health center and the community. Participants Two hundred seven girls (aged 11, 13, 15, and 17 years). Outcome Measures Bone mineral density (BMD) and content (BMC) of the hip, spine, and total body determined by dual-energy x-ray absorptiometry. Independent variables included self-report depressive symptoms, anxiety, and smoking history. Results Higher depressive symptoms were associated with lower total body BMC and BMD but not hip or spine BMC and BMD. Only in white adolescents was higher state anxiety associated with lower total body BMC and hip BMC and BMD. Ever-smokers were not significantly different than never-smokers in age-adjusted BMC or BMD, but they had higher depressive and anxiety symptoms. Although no significant depression or anxiety by smoking group interactions were found, subgroup analyses suggest that in ever-smokers, higher trait anxiety was related to lower total body BMC. Conclusions This is the first study to report that higher depressive and anxiety symptoms are associated with lower total body BMC during adolescence in girls. Knowing that this association is present at a young age is worrisome, as peak bone mass is attained in adolescence. Findings may aid in identifying girls who are at risk for low bone mass and developing intervention/prevention strategies during adolescence. Importantly, mechanisms that explain these associations and the effect of smoking on bone health need longitudinal examination.