title: Depressive symptomatology and fracture risk in community-dwelling older men and women.
abstract: OBJECTIVE
  Previous studies suggest that depression increases risk of falls, low bone mineral density, and fractures. Our aim was to evaluate whether depressive symptomatology alone predicts 5- year clinical fracture risk in older adults.
  
  
  METHODS
  In this secondary analysis of a community-based, prospective cohort study including 4175 women and 1652 men in Canada, depressive symptomatology was assessed at baseline by the mental health inventory-5 (MHI-5) and the mental component score (MCS) of the short form 36 questionnaire (SF-36). Fracture events were assessed annually for five years; all reported incident fragility fractures were confirmed radiographically.
  
  
  RESULTS
  Depressive symptomatology did not predict time to first fracture in men (hazard ratio [HR] 0.86, 95% confidence interval [CI] 0.45-1.65) or women (HR 1.09, 95% CI 0.86-1.39). Results were similar after controlling for potential confounders. Depressive symptoms were not significantly associated with baseline bone mineral density at the lumbar spine or femoral neck. Women with depressive symptoms were more likely to report falls in the previous month (odds ratio [OR] 1.52, 95% CI 1.12-2.06, p=0.01). This association did not achieve statistical significance in men (OR 1.71, 95% CI 0.96-3.04, p=0.07).
  
  
  CONCLUSIONS
  In this large, community cohort, depressive symptomatology did not predict five-year risk of clinical fracture. Further research is needed to determine if individuals with major depressive disorder (MDD) are at higher fracture risk and whether neuroendocrine or hormonal dysregulation might contribute to such risk in MDD.
authors.affiliation: Division of Geriatrics, Department of Medicine, Duke University, Durham, NC 27710, USA. heather.whitson@duke.edu
authors.forename: Heather E
authors.initials: HE
authors.lastname: Whitson
authors.forename: Linda
authors.initials: L
authors.lastname: Sanders
authors.forename: Carl F
authors.initials: CF
authors.lastname: Pieper
authors.forename: Deborah T
authors.initials: DT
authors.lastname: Gold
authors.forename: Alexandra
authors.initials: A
authors.lastname: Papaioannou
authors.forename: J Brent
authors.initials: JB
authors.lastname: Richards
authors.forename: Jonathan D
authors.initials: JD
authors.lastname: Adachi
authors.forename: Kenneth W
authors.initials: KW
authors.lastname: Lyles
mesh_terms: D000058:Accidental Falls / Q000706:statistics & numerical data*; D000368:Aged; D015519:Bone Density; D003863:Depression / Q000453:epidemiology*; D005260:Female; D005265:Femoral Neck Fractures / Q000453:epidemiology* / Q000523:psychology; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D010024:Osteoporosis / Q000453:epidemiology; D011237:Predictive Value of Tests; D015995:Prevalence; D012307:Risk Factors; D017678:Sex Distribution; D016103:Spinal Fractures / Q000453:epidemiology* / Q000523:psychology