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. 2008 May;23(5):567-74.
doi: 10.1007/s11606-008-0525-0. Epub 2008 Feb 20.

Depressive symptoms, bone loss, and fractures in postmenopausal women

Leslie Spangler  1 , Delia Scholes, Robert L Brunner, John Robbins, Susan D Reed, Katherine M Newton, Jennifer L Melville, Andrea Z Lacroix
Affiliations

Depressive symptoms, bone loss, and fractures in postmenopausal women

Leslie Spangler et al. J Gen Intern Med. 2008 May.

Abstract

Background: Osteoporosis and depression may be associated through common physiologic systems or risk factors.

Objective: To assess the associations between depressive symptoms (Burnam's scale) or antidepressant use and bone outcomes.

Design: Prospective cohort study.

Participants: A total of 93,676 postmenopausal women (50 to 79 years old) enrolled in the Women's Health Initiative Observational Study.

Measurements: Self-reported fractures (n = 14,982) (hip [adjudicated], spine, wrist, and "other"). Analyses included 82,410 women with complete information followed on average for 7.4 years. Bone mineral density (BMD) of the hip (n = 4539), spine (n = 4417), and whole body (n = 4502) was measured at baseline and 3 years in women enrolled at 3 densitometry study sites.

Results: Overall, there were no statistically significant associations between depressive symptoms or antidepressant therapy and 3-year change in BMD. In a subset of women not using antidepressants, there was a significant difference in whole-body BMD change between women with and without depressive symptoms (P = .05). Depressive symptoms (hazard ratio [HR] 1.08; 95% CI = 1.02 to 1.14) and antidepressant therapy (HR = 1.22; CI = 1.15 to 1.30) independently increased risk of any fracture, the majority of which occurred at "other" anatomic sites. Antidepressant therapy increased the risk of spine fracture (HR = 1.36; CI = 1.14 to 1.63). No associations were observed between depressive symptoms or antidepressant therapy and hip or wrist fracture.

Conclusion: In this study of postmenopausal women, average age 64, we observed minimal association between depressive symptoms and 3-year changes in either BMD or fracture risk. Antidepressant use was not associated with changes in BMD, but was associated with increased risk of fractures at the spine and "other " anatomic sites.

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References

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