title: Symptoms of anxiety or depression and risk of fracture in older people: the Hertfordshire Cohort Study.
abstract: The aim of this study was to examine the prospective association between symptoms of anxiety and depression and risk of fracture in older people. Results showed that men, but not women, with probable anxiety at baseline had an increased risk of fracture.
  
  
  BACKGROUND
  The use of psychotropic drugs has been linked with an increased risk of fracture in older people, but there are indications that the conditions for which these drugs were prescribed may themselves influence fracture risk. The aim of this study was to investigate the relation between symptoms of anxiety and depression and risk of fracture in older people. The study design is a prospective cohort study.
  
  
  METHODS
  One thousand eighty-seven men and 1,050 women aged 59-73 years completed the Hospital Anxiety and Depression Scale (HADS). Data on incident fracture during an average follow-up period of 5.6 years were collected through interview and a postal questionnaire.
  
  
  RESULTS
  Compared to men with no or few symptoms of anxiety (score ≤7 on the HADS anxiety subscale), men with probable anxiety (score ≥11) had an increased risk of fracture: After adjustment for age and potential confounding factors, the odds ratio (OR) (95 % confidence interval) was 4.03 (1.55, 10.5). There were no associations between levels of anxiety and fracture risk in women. Few men or women had probable depression at baseline (score ≥11 on the HADS depression subscale). Amongst men with possible depression (score 8-10), there was an increased risk of fracture that was of borderline significance: multivariate-adjusted OR 3.57 (0.99, 12.9). There was no association between possible depression and fracture risk in women.
  
  
  CONCLUSIONS
  High levels of anxiety in older men may increase their risk of fracture. Future research needs to replicate this finding in other populations and investigate the underlying mechanisms.
authors.affiliation: MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK. crg@mrc.soton.ac.uk
authors.forename: Catharine R
authors.initials: CR
authors.lastname: Gale
authors.forename: Elaine M
authors.initials: EM
authors.lastname: Dennison
authors.forename: Mark
authors.initials: M
authors.lastname: Edwards
authors.forename: Avan Aihie
authors.initials: AA
authors.lastname: Sayer
authors.forename: Cyrus
authors.initials: C
authors.lastname: Cooper
mesh_terms: D017677:Age Distribution; D000368:Aged; D000375:Aging; D001007:Anxiety / Q000188:drug therapy / Q000453:epidemiology*; D003863:Depression / Q000188:drug therapy / Q000453:epidemiology*; D005260:Female; D005500:Follow-Up Studies; D050723:Fractures, Bone / Q000453:epidemiology* / Q000523:psychology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010024:Osteoporosis / Q000453:epidemiology* / Q000523:psychology*; D011446:Prospective Studies; D011619:Psychotropic Drugs / Q000009:adverse effects; D012307:Risk Factors; D017678:Sex Distribution; D011795:Surveys and Questionnaires
chemical_list: D011619:Psychotropic Drugs