Original Article

Journal of General Internal Medicine

, Volume 23, Issue 5, pp 567-574

First online:

Depressive Symptoms, Bone Loss, and Fractures in Postmenopausal Women

  • Leslie SpanglerAffiliated withGroup Health Center for Health Studies Email author 
  • , Delia ScholesAffiliated withGroup Health Center for Health Studies
  • , Robert L. BrunnerAffiliated withFamily and Community Medicine, University of Nevada School of Medicine
  • , John RobbinsAffiliated withDepartment of Medicine, University of California Davis
  • , Susan D. ReedAffiliated withGroup Health Center for Health StudiesDepartment of Epidemiology, University of WashingtonPublic Health Sciences Division, Fred Hutchinson Cancer Research CenterDepartment of Obstetrics and Gynecology, School of Medicine, University of Washington
  • , Katherine M. NewtonAffiliated withGroup Health Center for Health StudiesDepartment of Epidemiology, University of Washington
  • , Jennifer L. MelvilleAffiliated withGroup Health Center for Health StudiesDepartment of Obstetrics and Gynecology, School of Medicine, University of WashingtonDepartment of Psychiatry and Behavioral Sciences, University of Washington
  • , Andrea Z. LaCroixAffiliated withGroup Health Center for Health StudiesDepartment of Epidemiology, University of WashingtonPublic Health Sciences Division, Fred Hutchinson Cancer Research Center

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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 symptoms antidepressants bone density fractures prospective