title: Depression and hip fracture risk: the NHANES I epidemiologic follow-up study.
abstract: OBJECTIVE
  Since hip fracture is the most devastating consequence of osteoporosis from a public health standpoint, addressing whether depression is predictive of fracture risk is important. The purpose of this study is to determine whether individuals with high depressive symptomatology are more likely to suffer an osteoporotic hip fracture than subjects with intermediate or low depressive symptomatology.
  
  
  METHODS
  Data from the first National Health and Nutrition Examination Survey (NHANES I) were obtained from a nationally representative sample of noninstitutionalized civilians. A cohort aged 25 through 74 at baseline (1971-1975) was observed through 1992. Subjects were followed-up for a maximum of 22 years. Included in the analyses were 6,195 white and black subjects. Ninety-five percent of the original cohort completed the study. Hospital records and death certificates were used to identify a total of 122 hip fracture cases.
  
  
  RESULTS
  In an unadjusted Cox proportional hazards regression model for all individuals, depression was predictive of hip fracture (hazard ratio [HR]=1.90; 95% confidence interval [CI]=1.13, 3.21; p=0.016). In a multivariate proportional hazards model controlling for (1) age at baseline, (2) gender, (3) race, (4) body mass index, (5) smoking status, (6) alcohol consumption, and (7) physical activity level, high depressive symptomatology remained predictive of hip fracture (HR=1.70; 95% CI=0.99, 2.91; p=0.055).
  
  
  CONCLUSIONS
  This study gives evidence of a prospective association between depression and hip fracture. Additional studies are needed to verify these findings and to elucidate the pathways for the effects of depression on hip fracture incidence.
authors.affiliation: National Center for Health Statistics, Centers for Disease Control and Prevention, Hyattsville, MD 20782, USA. MMussolino@cdc.gov
authors.forename: Michael E
authors.initials: ME
authors.lastname: Mussolino
mesh_terms: D000328:Adult; D000368:Aged; D003866:Depressive Disorder / Q000453:epidemiology*; D005260:Female; D006620:Hip Fractures / Q000453:epidemiology* / Q000517:prevention & control; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009749:Nutrition Surveys; D010024:Osteoporosis / Q000453:epidemiology* / Q000517:prevention & control; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012306:Risk; D014481:United States / Q000453:epidemiology
references.citation: Maturitas. 1999 Oct 24;33(2):133-7
references.pmid: 10597877
references.citation: Prostaglandins Leukot Essent Fatty Acids. 1999 Apr;60(4):217-34
references.pmid: 10397403
references.citation: Am J Psychiatry. 2000 Jan;157(1):118-20
references.pmid: 10618024
references.citation: Psychosom Med. 2000 Nov-Dec;62(6):779-82
references.pmid: 11138996
references.citation: J Am Geriatr Soc. 2001 Jun;49(6):732-6
references.pmid: 11454111
references.citation: Psychiatry Res. 2003 Mar 25;117(3):271-5
references.pmid: 12686369
references.citation: Vital Health Stat 1. 1973 Feb;(10a):1-46
references.pmid: 4347506
references.citation: Vital Health Stat 2. 1977 Sep;(73):1-53
references.pmid: 610049
references.citation: J Affect Disord. 1986 Nov-Dec;11(3):265-74
references.pmid: 3031145
references.citation: Vital Health Stat 1. 1987 Jun;(22):1-142
references.pmid: 3672939
references.citation: Community Med. 1988 May;10(2):117-23
references.pmid: 3243063
references.citation: JAMA. 1989 Sep 1;262(9):1191-5
references.pmid: 2761060
references.citation: JAMA. 1990 Sep 26;264(12):1541-5
references.pmid: 2395193
references.citation: JAMA. 1990 Sep 26;264(12):1546-9
references.pmid: 2395194
references.citation: Vital Health Stat 1. 1990 Sep;(25):1-154
references.pmid: 2238484
references.citation: Am J Public Health. 1992 Feb;82(2):243-8
references.pmid: 1739155
references.citation: Am J Prev Med. 1991 Nov-Dec;7(6):425-37
references.pmid: 1790054
references.citation: Vital Health Stat 1. 1992 Sep;(27):1-190
references.pmid: 1413562
references.citation: Adv Data. 1993 Nov 4;(236):1-16
references.pmid: 10171806
references.citation: Am J Psychiatry. 1994 Nov;151(11):1691-3
references.pmid: 7943462
references.citation: Psychosom Med. 1995 Sep-Oct;57(5):485-91
references.pmid: 8552740
references.citation: N Engl J Med. 1996 Oct 17;335(16):1176-81
references.pmid: 8815939
references.citation: Vital Health Stat 1. 1997 Dec;(35):1-231
references.pmid: 9564279
references.citation: Prog Neuropsychopharmacol Biol Psychiatry. 1998 Feb;22(2):267-77
references.pmid: 9608600
references.citation: Prog Lipid Res. 1997 Sep;36(2-3):131-51
references.pmid: 9624425
references.citation: Lancet. 1998 May 2;351(9112):1303-7
references.pmid: 9643791
references.citation: Arch Intern Med. 1999 Mar 8;159(5):484-90
references.pmid: 10074957
references.citation: J Psychosom Res. 1999 Jan;46(1):29-35
references.pmid: 10088979