title: Depression as a risk factor for fracture in women: A 10 year longitudinal study.
abstract: BACKGROUND
  Previous research has demonstrated deficits in bone mineral density (BMD) among individuals with depression. While reduced BMD is a known risk for fracture, a direct link between depression and fracture risk is yet to be confirmed.
  
  
  METHODS
  A population-based sample of women participating in the Geelong Osteoporosis Study was studied using both nested case-control and retrospective cohort study designs. A lifetime history of depression was identified using a semi-structured clinical interview (SCID-I/NP). Incident fractures were identified from radiological reports and BMD was measured at the femoral neck using dual energy absorptiometry. Anthropometry was measured and information on medication use and lifestyle factors was obtained via questionnaire.
  
  
  RESULTS
  Among 179 cases with incident fracture and 914 controls, depression was associated with increased odds of fracture (adjusted odds ratio (OR) 1.57, 95%CI 1.04-2.38); further adjustment for psychotropic medication use appeared to attenuate this association (adjusted OR 1.52, 95%CI 0.98-2.36). Among 165 women with a history of depression at baseline and 693 who had no history of depression, depression was associated with a 68% increased risk of incident fracture (adjusted hazard ratio (HR) 1.68, 95%CI 1.02-2.76), with further adjustment for psychotropic medication use also appearing to attenuate this association (adjusted HR 1.58, 95%CI 0.95-2.61).
  
  
  CONCLUSIONS
  Potential limitations include recall bias, unrecognised confounding and generalizability.
  
  
  CONCLUSIONS
  This study provides both cross-sectional and longitudinal evidence to suggest that clinical depression is a risk factor for radiologically-confirmed incident fracture, independent of a number of known risk factors. If there is indeed a clinically meaningful co-morbidity between mental and bone health, potentially worsened by psychotropic medications, the issue of screening at-risk populations needs to become a priority.
authors.affiliation: Deakin University, School of Medicine, IMPACT Strategic Research Centre, Geelong, Australia. Electronic address: lanaw@barwonhealth.org.au.
authors.forename: Lana J
authors.initials: LJ
authors.lastname: Williams
authors.affiliation: Deakin University, School of Medicine, IMPACT Strategic Research Centre, Geelong, Australia; The University of Melbourne, Department of Medicine, St Albans, Australia. Electronic address: juliep@barwonhealth.org.au.
authors.forename: Julie A
authors.initials: JA
authors.lastname: Pasco
authors.affiliation: The University of Melbourne, Melbourne School of Psychological Sciences, Australia. Electronic address: henryjj@unimelb.edu.au.
authors.forename: Henry
authors.initials: H
authors.lastname: Jackson
authors.affiliation: The University of Melbourne, Melbourne School of Psychological Sciences, Australia; Royal Melbourne Hospital, Psychology Department, Australia. Electronic address: litzak@unimelb.edu.au.
authors.forename: Litza
authors.initials: L
authors.lastname: Kiropoulos
authors.affiliation: Deakin University, School of Medicine, IMPACT Strategic Research Centre, Geelong, Australia. Electronic address: amandh@barwonhealth.org.au.
authors.forename: Amanda L
authors.initials: AL
authors.lastname: Stuart
authors.affiliation: Deakin University, School of Medicine, IMPACT Strategic Research Centre, Geelong, Australia; The University of Melbourne, Department of Psychiatry, Parkville, Australia. Electronic address: f.jacka@deakin.edu.au.
authors.forename: Felice N
authors.initials: FN
authors.lastname: Jacka
authors.affiliation: Deakin University, School of Medicine, IMPACT Strategic Research Centre, Geelong, Australia; The University of Melbourne, Department of Psychiatry, Parkville, Australia; The University of Melbourne, The Florey Institute of Neuroscience and Mental Health, Parkville, Australia; The University of Melbourne, Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, Australia. Electronic address: mikebe@barwonhealth.org.au.
authors.forename: Michael
authors.initials: M
authors.lastname: Berk
mesh_terms: D015502:Absorptiometry, Photon; D000328:Adult; D000368:Aged; D015519:Bone Density; D016022:Case-Control Studies; D003430:Cross-Sectional Studies; D003863:Depression / Q000150:complications* / Q000188:drug therapy; D003866:Depressive Disorder / Q000150:complications* / Q000188:drug therapy; D005260:Female; D005272:Femur Neck / Q000000981:diagnostic imaging; D050723:Fractures, Bone / Q000523:psychology*; D006801:Humans; D008137:Longitudinal Studies; D008875:Middle Aged; D016017:Odds Ratio; D010024:Osteoporosis / Q000523:psychology; D016016:Proportional Hazards Models; D011619:Psychotropic Drugs / Q000627:therapeutic use; D012189:Retrospective Studies; D012307:Risk Factors; D011795:Surveys and Questionnaires
chemical_list: D011619:Psychotropic Drugs
keywords: Bone; Bone mineral density; Depression; Fracture; Osteoporosis; Women