Title: The impact of Endocrine modulation and renal function in relationship between osteoporosis and mental illness among geriatric populations : a cross sectional study.

ABSTRACT Background:Renal osteodystrophy is a common long term complication of end stage renal disease. We hereby present a case of unusual presentation of renal osteodystrophy in the senile female group showed depression induced osteoporosis to be more endocrine dependent than in male where it is more biochemical oriented.Importantly, progression of CKD is associated with a number of serious complications, including mineral metabolism disorders and bone pathology, and these are independently associated with fractures, accelerated vascular calcification, outcomes 1,2,3.Consequently,CKD-mineral and bone disorders is a currently accepted term which refers to a systemic disorder of mineral and bone metabolism due to CKD manifested by various laboratory, bone, and vascular abnormalities 1,2,3,4 .Since bone quality is probably another important aspect to be taken into account which may be additionally affected in the presence of CKD 5, new tools are being developed to improve its assessment and improve fracture risk prediction both in the general population and in CKD patients 6.To design a treatment plan and prevent complications in patients of renal disorder with low bone mineral density associated with depression,understanding the pathophysiology of these two bone disorders is necessary. Aim: The aim of this present study is to find a new unrecognized risk factor of secondary osteoporosis in Senile age group. Methods: This was an analytical cross sectional study conducted in department of physiology and Orthopeadic KPCMCH, Kolkata,India.Depression was determine by using HamD scale,Bone biomarker(BMDanalysis )Screening by Ultrasound followed by DEXA(dual energy X-ray absorptiometry.TSH measured by chemiluminisence, cortisol and Vitamin D will be measured by immunoassay,Biochemical estimation (FBS,creatinine,eGFR)Colorimeter Automated sys400 Quantitative.Quantitative estimation of serum Creatinine by Jaffe”s method & Calculated by using estimated GFR calculator after getting creatinine value. Results: The participants of the present study includes 80 subjects.The BMD score of these normal subjects was - 0.72 ±0.16 and - 0.7 ±0.16 in males and females respectively. The results in the aged group (65-80) elicits a HAM D score of 5.4 ±2.11 and 4.2±2.14 in normal males and females respectively. In contrast the HAM D score of male case group is 18.45±2.39 and that of the female is 20.2 ±1.88. It has already been stated that the BMD of the patients of the elderly group is more negative compared to other group indicating the presence of osteopenia/osteoporosis. Incidentally the serum cortisol level of this group of cases is higher than that of their normal counterparts.Serum creatinine level is significantly higher in male groups (2.02 ±0.40) than in female (0.87 ±0.25). This high level of serum creatinine is associated with impaired renal function and lower eGFR (41.4±6.19 in male and 55.8±20.80 in female).eGFR in control group male is significantly raised, 122±34.46in male and 98.35±33.21in female. So downward trend of eGFR is present in subjects with higher negative BMD scores. This also indirectly signifies chronic renal disease which causes less eGFR is inversely related with osteoporosis. Conclusion: First time we found a new etiology that depression is significantly associated with renal dysfunction which induce osteoporosis in senile male age group. So it can be concluded that depression associated renal osteodystrophy may be a significant cause of osteoporosis specially in male population of geriatric group.