Depression and the risk of fractures in later life: the Health In Men cohort study

Almeida, Osvaldo P., Hankey, Graeme J., Golledge, Jonathan, Yeap, Bu B., and Flicker, Leon (2021) Depression and the risk of fractures in later life: the Health In Men cohort study. Maturitas, 145. pp. 6-11.

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Introduction: Fractures are common and disabling health events, particularly later in life. The presence of clinically significant depressive symptoms has been associated with increased risk of fractures, and we designed the present study to clarify if this association is likely to be causal or due to the confounding effect of measures associated with both fractures and depression.

Method: Cohort study of a community-derived sample of 4224 men aged 70 to 88 years at the start of the follow-up period of up to 17 years. Clinically significant symptoms of depression were defined as a recorded diagnosis of depressive episode in the Western Australian Data Linkage System (WADLS) or by a total score of 7 or greater on the 15-item Geriatric Depression Scale. Health contacts associated with fractures were retrieved from WADLS. Other measures included age, past history of fractures, education, smoking, frailty, poor vision, falls, medications, and the concentration of vitamin D, homocysteine, hsCRP and testosterone. Death was considered a competing risk for fractures.

Results: 911 (21.6%) participants had a bone fracture during follow-up. After adjustment for multiple potential confounders, past and current depression were associated with an increase in the risk of novel fractures; respective odds ratios were 1.41 (95%CI = 1.03, 1.93) and 1.64 (95%CI = 1.20, 2.25). Parsimonious competing risk regression showed that both past and current depression were associated with an increase in the risk of novel fractures: sub-hazard ratio = 1.29 (95%CI = 1.03, 1.63) and 1.27 (95%CI = 1.05, 1.55) respectively. Estimation of confounding due to unmeasured factors showed that a small additional effect could potentially dilute the association between depression and fractures.

Discussion: History of clinically significant symptoms of depression is associated with an increased risk of future fractures. This association may be due to multiple other associated risk factors, both measured and unmeasured, but nevertheless the presence of depression should alert clinicians to the need to develop a management plan that includes the management not only of depression but also of fracture risk.

Item ID: 67040
Item Type: Article (Research - C1)
ISSN: 0378-5122
Keywords: aged; antidepressants; cohort study; depression; epidemiology; falls; fractures.
Copyright Information: © 2020 Elsevier B.V. All rights reserved.
Funders: National Health and Medical Research Council of Australia (NHMRC)
Projects and Grants: NHMRC 279408, NHMRC 379600, NHMRC 403963, NHMRC 513823, NHMRC 540403, NHMRC 540504, NHMRC 540405, NHMRC 634492, NHMRC 1021416, NHMRC 1045710, NHMRC 1060557
Date Deposited: 21 Jun 2021 01:15
FoR Codes: 32 BIOMEDICAL AND CLINICAL SCIENCES > 3201 Cardiovascular medicine and haematology > 320199 Cardiovascular medicine and haematology not elsewhere classified @ 100%
SEO Codes: 20 HEALTH > 2001 Clinical health > 200105 Treatment of human diseases and conditions @ 50%
20 HEALTH > 2005 Specific population health (excl. Indigenous health) > 200504 Men's health @ 50%
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