Depression, Falls, and Risk of Fracture in Older Women

Abstract

Results: The prevalence of depression (Geriatric De- pression Scale score $ 6) was 6.3% (467/7414). We found no difference in mean BMD of the hip and lumbar spine in women with depression compared with those with- out depression. Women with depression were more likely to experience subsequent falls than women without de- pression (70% vs 59%; age-adjusted odds ratio (OR), 1.6; 95% confidence interval (CI), 1.3-1.9; P,.001), an as- sociation that persisted after adjusting for potential con- founding variables (OR, 1.4; 95% CI, 1.1-1.8; P = .004). Women with depression had a 40% (age-adjusted hazard ratio (HR), 1.4; 95% CI, 1.2-1.7; P,.001) increased rate of nonvertebral fracture (124 fractures in 3805 woman- years of follow-up) compared with women without de- pression (1367 fractures in 59 503 woman-years of follow- up). This association remained strong after adjusting for potential confounding variables, including medication use and neuromuscular function (HR, 1.3; 95% CI, 1.1-1.6; P = .008). Further adjustment for subsequent falls ap- peared to explain part of this association (HR, 1.2; 95% CI, 1.0-1.5; P = .06). Women with depression were also more likely to suffer vertebral fractures than women with- out depression, adjusting for history of vertebral frac- ture, history of falling, arthritis, diabetes, steroid use, es- trogen use, supplemental calcium use, cognitive function, and hip BMD (OR, 2.1; 95% CI, 1.4-3.2; P,.001). Conclusions: Depression is a significant risk factor for fracture in older women. The greater frequency of falls among individuals with depression partially explains this finding. Other mechanisms responsible for the associa- tion between depression and fracture remain to be determined.