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Depression and risk of fracture and bone loss: an updated meta-analysis of prospective studies

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Abstract

Summary

This meta-analysis pooled results from 23 qualifying individual cohort studies and found that depression was significantly associated with an increased risk of fractures and bone loss.

Introduction

The association between depression and risk of fracture remains controversial. We conducted a comprehensive meta-analysis to examine the effect of depression on the risk of osteoporotic fractures and bone loss.

Methods

We searched databases and reviewed citations in relevant articles for eligible cohort studies. Two investigators independently conducted study selection, appraisal, and data abstraction through the use of a standardized protocol. Random effect models were used for meta-analysis. Cochrane Q and I2 statistics were used to assess heterogeneity. Funnel plots and rank correlation tests were used to evaluate publication bias.

Results

Twenty-three studies were included for meta-analysis. In studies that reported hazard ratio (HR) as the outcome (nine studies [n = 309,862]), depression was associated with 26% increase in fracture risk (HR = 1.26, 95% CI, 1.10–1.43, p < 0.001). Studies that reported risk ratio (RR) as the outcome (seven studies [n = 64,975]) suggested that depression was associated with 39% increase in fracture risk (RR = 1.39, 95% CI, 1.19–1.62, p < 0.001). Among studies that reported hip bone mineral density (BMD) as an outcome (eight studies [n = 15,442]), depression was associated with a reduced mean annual bone loss rate of 0.35% (0.18–0.53%, p < 0.001). The increased risk of fracture and bone loss associated with depression was consistent in all meta-analysis having modified inclusion criteria and in different subgroup analyses as well. Significant heterogeneity was observed in the meta-analysis; however, no significant publication bias was detected.

Conclusion

Depression is associated with a significant increased risk in fracture and bone loss. Effective prevention may decrease such risk.

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Abbreviations

BMD:

Bone mineral density

HR:

Hazard ratio

OR:

Odd ratio

RR:

Risk ratio

MDD:

Major depressive disorder

CI:

Confidence interval

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Funding

The project was supported by the Fund of Knowledge from University of Nevada, Las Vegas.

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Authors and Affiliations

  1. Nevada Institute of Personalized Medicine, Department of Environmental & Occupational Health School of Community Health Sciences, University of Nevada, Las Vegas, NV, 89154, USA

    Q. Wu & B. Liu

  2. Department of Mathematical Science, University of Nevada, Las Vegas, NV, USA

    B. Liu & S. Tonmoy

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  1. Q. Wu
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Correspondence to Q. Wu.

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Wu, Q., Liu, B. & Tonmoy, S. Depression and risk of fracture and bone loss: an updated meta-analysis of prospective studies. Osteoporos Int 29, 1303–1312 (2018). https://doi.org/10.1007/s00198-018-4420-1

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