Osteoporosis Could Signal Increased Risk of Depression in Older Adults

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In addition to the increased risk of fracture, a new study suggests osteoporosis could put older adults at an increased risk of depression.¹

In a new study, led by Keng Cheng from the department of orthopedics at The Eighth Affiliated Hospital in Sun Yat-sen University, China, results indicate Individuals with osteoporosis had a 73% greater risk of experiencing depression symptoms than individuals without osteoporosis.

“Our findings indicated the necessity to evaluate and take care of mental health for older adults with osteoporosis to improve their life quality and diminish disease burden,” wrote investigators.

The most common form of arthritis globally, osteoporosis is characterized by low bone mass and deterioration of bone tissue. According to a study published in 2023, the condition affects 14.8% of the global population older than 30.²

For their cross-sectional study, Cheng and colleagues obtained data from the US National Health and Nutrition Examination Survey in 2005 – 2006, 2007 – 2008, 2009 – 2010, 2013 – 2014, and 2017 – 2020. The osteoporosis diagnosis was based on bone mineral density of the femoral neck measured by dual-energy X-ray absorptiometry. Depression was characterized as a Patient Health Questionnaire-9 score of >5 with a score of ≥ 10 as probable depression.

The study included 11,603 adults aged ≥ 50 years old and 5.2% (n = 604) with osteoporosis. Of the participants with osteoporosis, 31.9% had depressive symptoms and 10% had probable depression. Participants with osteoporosis were more likely to be older (70.9 years vs. 62.6 years; P < .0001), female (84.6% vs. 49.4%; P < .001), non-Hispanic White (83.2% vs. 75.9%; P < .001), current smokers (19.6% vs. 15.1%; P < .001), less likely to have a BMI ≥ 25 kg/m2 (41.7% vs. 75.3%; P < .001), less likely to have education level greater than college graduate or above (49.6% vs. 58.8%; P < .001), and less likely to be married or living with someone as if married (48.1% vs. 68%; P < .001).

After adjusting for sex, age, race/ethnicity, education, marital status, family income, BMI, smoking, physical activity, and alcohol abuse, individuals with osteoporosis were 1.73 times more likely to experience depressive symptoms (odds ratio [OR], 1.73; 95% confidence interval [CI], 1.20 – 2.50), and 1.91 times more likely to experience probable depression (OR, 1.91; 95% CI, 1.02 – 3.59). After excluding participants who use antidepressants, the fully adjusted model showed participants with osteoporosis had an 82% greater risk of depressive symptoms (OR, 1.82; 95% CI, 1.18 – 2.81; P = .008).

The team said several potential explanations could support the findings. For instance, bone mass loss and deterioration of bone tissues can increase the risk of fractures, comorbidities, or death. Moreover, the condition can cause financial burdens and lead people to avoid moderate-vigorous physical activity due to fear of falls and fractures.

“The long-term disease of osteoporosis could lead to deformity of skeleton that may cause a reduction in self-esteem, inability to meet role expectations, dependence on caregivers but isolation from familiar social relationships, therefore, higher possibility of depression than in healthy people,” investigators wrote.

The investigators stated a limitation of the study was the cross-sectional design of NHANES since they could not infer a causal relationship between osteoporosis and depression. Still, they did conduct 2 sensitivity analyses to support the associations.

Additionally, the depression evaluations were self-administrated, opening room for social desirability bias and affecting the depression level. There also could have missed some confounding factors, such as cumulative marijuana use.

“Our findings highlighted the importance of paying close attention to the psychological status of osteoporosis patients,” investigators wrote. “It may be necessary to evaluate the mental well-being of patients with osteoporosis in clinical and primary health care.”

^References

1. ^{Chen K, Wang T, Tong X, et al. Osteoporosis is associated with depression among older adults: a nationwide population-based study in the USA from 2005 to 2020. Public Health. 2024;226:27-31. doi:10.1016/j.puhe.2023.10.022}
2. ^{Pine, L. Osteoarthritis Affects 15% of People Over Age 30. August 23, 2023. https://www.hcplive.com/view/osteoarthritis-affects-15-of-people-over-age-30. Accessed January 19, 2024.}