Journal of General Internal Medicine

, Volume 23, Issue 5, pp 567–574

Depressive Symptoms, Bone Loss, and Fractures in Postmenopausal Women

Authors

    • Group Health Center for Health Studies
  • Delia Scholes
    • Group Health Center for Health Studies
  • Robert L. Brunner
    • Family and Community MedicineUniversity of Nevada School of Medicine
  • John Robbins
    • Department of MedicineUniversity of California Davis
  • Susan D. Reed
    • Group Health Center for Health Studies
    • Department of EpidemiologyUniversity of Washington
    • Public Health Sciences DivisionFred Hutchinson Cancer Research Center
    • Department of Obstetrics and Gynecology, School of MedicineUniversity of Washington
  • Katherine M. Newton
    • Group Health Center for Health Studies
    • Department of EpidemiologyUniversity of Washington
  • Jennifer L. Melville
    • Group Health Center for Health Studies
    • Department of Obstetrics and Gynecology, School of MedicineUniversity of Washington
    • Department of Psychiatry and Behavioral SciencesUniversity of Washington
  • Andrea Z. LaCroix
    • Group Health Center for Health Studies
    • Department of EpidemiologyUniversity of Washington
    • Public Health Sciences DivisionFred Hutchinson Cancer Research Center
Original Article

DOI: 10.1007/s11606-008-0525-0

Cite this article as:
Spangler, L., Scholes, D., Brunner, R.L. et al. J GEN INTERN MED (2008) 23: 567. doi:10.1007/s11606-008-0525-0

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.

KEY WORDS

depressive symptomsantidepressantsbone densityfracturesprospective

Copyright information

© Society of General Internal Medicine 2008