Skip to main content
NCBI home page
Public Health Reports logoLink to Public Health Reports
. 2005 Jan-Feb;120(1):71–75. doi: 10.1177/003335490512000112

Depression and hip fracture risk: the NHANES I epidemiologic follow-up study.

Michael E Mussolino 1
PMCID: PMC1497689  PMID: 15736334

Abstract

OBJECTIVE: Since hip fracture is the most devastating consequence of osteoporosis from a public health standpoint, addressing whether depression is predictive of fracture risk is important. The purpose of this study is to determine whether individuals with high depressive symptomatology are more likely to suffer an osteoporotic hip fracture than subjects with intermediate or low depressive symptomatology. METHODS: Data from the first National Health and Nutrition Examination Survey (NHANES I) were obtained from a nationally representative sample of noninstitutionalized civilians. A cohort aged 25 through 74 at baseline (1971-1975) was observed through 1992. Subjects were followed-up for a maximum of 22 years. Included in the analyses were 6,195 white and black subjects. Ninety-five percent of the original cohort completed the study. Hospital records and death certificates were used to identify a total of 122 hip fracture cases. RESULTS: In an unadjusted Cox proportional hazards regression model for all individuals, depression was predictive of hip fracture (hazard ratio [HR]=1.90; 95% confidence interval [CI]=1.13, 3.21; p=0.016). In a multivariate proportional hazards model controlling for (1) age at baseline, (2) gender, (3) race, (4) body mass index, (5) smoking status, (6) alcohol consumption, and (7) physical activity level, high depressive symptomatology remained predictive of hip fracture (HR=1.70; 95% CI=0.99, 2.91; p=0.055). CONCLUSIONS: This study gives evidence of a prospective association between depression and hip fracture. Additional studies are needed to verify these findings and to elucidate the pathways for the effects of depression on hip fracture incidence.

Full Text

The Full Text of this article is available as a PDF (68.9 KB).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Amsterdam J. D., Hooper M. B. Bone density measurement in major depression. Prog Neuropsychopharmacol Biol Psychiatry. 1998 Feb;22(2):267–277. doi: 10.1016/s0278-5846(98)00003-7. [DOI] [PubMed] [Google Scholar]
  2. Amsterdam J. D., Maislin G., Abelman E., Berwish N., Winokur A. Adrenocortical responsiveness to the ACTH stimulation test in depressed patients and healthy volunteers. J Affect Disord. 1986 Nov-Dec;11(3):265–274. doi: 10.1016/0165-0327(86)90078-9. [DOI] [PubMed] [Google Scholar]
  3. Anda R. F., Williamson D. F., Escobedo L. G., Mast E. E., Giovino G. A., Remington P. L. Depression and the dynamics of smoking. A national perspective. JAMA. 1990 Sep 26;264(12):1541–1545. [PubMed] [Google Scholar]
  4. Coelho R., Silva C., Maia A., Prata J., Barros H. Bone mineral density and depression: a community study in women. J Psychosom Res. 1999 Jan;46(1):29–35. doi: 10.1016/s0022-3999(98)00064-6. [DOI] [PubMed] [Google Scholar]
  5. Cohen B. B., Barbano H. E., Cox C. S., Feldman J. J., Finucane F. F., Kleinman J. C., Madans J. H. Plan and operation of the NHANES I Epidemiologic Followup Study: 1982-84. Vital Health Stat 1. 1987 Jun;(22):1–142. [PubMed] [Google Scholar]
  6. Cox C. S., Mussolino M. E., Rothwell S. T., Lane M. A., Golden C. D., Madans J. H., Feldman J. J. Plan and operation of the NHANES I Epidemiologic Followup Study, 1992. Vital Health Stat 1. 1997 Dec;(35):1–231. [PubMed] [Google Scholar]
  7. Cox C. S., Rothwell S. T., Madans J. H., Finucane F. F., Freid V. M., Kleinman J. C., Barbano H. E., Feldman J. J. Plan and operation of the NHANES I Epidemiologic Followup Study, 1987. Vital Health Stat 1. 1992 Sep;(27):1–190. [PubMed] [Google Scholar]
  8. Fazio A. F. A concurrent validational study of the NCHS General Well-Being Schedule. Vital Health Stat 2. 1977 Sep;(73):1–53. [PubMed] [Google Scholar]
  9. Finucane F. F., Freid V. M., Madans J. H., Cox C. S., Kleinman J. C., Rothwell S. T., Barbano H. E., Feldman J. J. Plan and operation of the NHANES I Epidemiologic Followup Study, 1986. Vital Health Stat 1. 1990 Sep;(25):1–154. [PubMed] [Google Scholar]
  10. Fisher E. S., Whaley F. S., Krushat W. M., Malenka D. J., Fleming C., Baron J. A., Hsia D. C. The accuracy of Medicare's hospital claims data: progress has been made, but problems remain. Am J Public Health. 1992 Feb;82(2):243–248. doi: 10.2105/ajph.82.2.243. [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. Glassman A. H., Helzer J. E., Covey L. S., Cottler L. B., Stetner F., Tipp J. E., Johnson J. Smoking, smoking cessation, and major depression. JAMA. 1990 Sep 26;264(12):1546–1549. [PubMed] [Google Scholar]
  12. Halbreich U., Rojansky N., Palter S., Hreshchyshyn M., Kreeger J., Bakhai Y., Rosan R. Decreased bone mineral density in medicated psychiatric patients. Psychosom Med. 1995 Sep-Oct;57(5):485–491. doi: 10.1097/00006842-199509000-00011. [DOI] [PubMed] [Google Scholar]
  13. Herrán A., Amado J. A., García-Unzueta M. T., Vázquez-Barquero J. L., Perera L., González-Macías J. Increased bone remodeling in first-episode major depressive disorder. Psychosom Med. 2000 Nov-Dec;62(6):779–782. doi: 10.1097/00006842-200011000-00006. [DOI] [PubMed] [Google Scholar]
  14. Horrobin D. F., Bennett C. N. Depression and bipolar disorder: relationships to impaired fatty acid and phospholipid metabolism and to diabetes, cardiovascular disease, immunological abnormalities, cancer, ageing and osteoporosis. Possible candidate genes. Prostaglandins Leukot Essent Fatty Acids. 1999 Apr;60(4):217–234. doi: 10.1054/plef.1999.0037. [DOI] [PubMed] [Google Scholar]
  15. Kruger M. C., Horrobin D. F. Calcium metabolism, osteoporosis and essential fatty acids: a review. Prog Lipid Res. 1997 Sep;36(2-3):131–151. doi: 10.1016/s0163-7827(97)00007-6. [DOI] [PubMed] [Google Scholar]
  16. Liu B., Anderson G., Mittmann N., To T., Axcell T., Shear N. Use of selective serotonin-reuptake inhibitors or tricyclic antidepressants and risk of hip fractures in elderly people. Lancet. 1998 May 2;351(9112):1303–1307. doi: 10.1016/s0140-6736(97)09528-7. [DOI] [PubMed] [Google Scholar]
  17. Michelson D., Stratakis C., Hill L., Reynolds J., Galliven E., Chrousos G., Gold P. Bone mineral density in women with depression. N Engl J Med. 1996 Oct 17;335(16):1176–1181. doi: 10.1056/NEJM199610173351602. [DOI] [PubMed] [Google Scholar]
  18. Miller H. W. Plan and operation of the health and nutrition examination survey. United states--1971-1973. Vital Health Stat 1. 1973 Feb;(10A):1–46. [PubMed] [Google Scholar]
  19. Pemberton J. Are hip fractures underestimated as a cause of death? The influence of coroners and pathologists on the death rate. Community Med. 1988 May;10(2):117–123. [PubMed] [Google Scholar]
  20. Reginster J. Y., Deroisy R., Paul I., Hansenne M., Ansseau M. Depressive vulnerability is not an independent risk factor for osteoporosis in postmenopausal women. Maturitas. 1999 Oct 24;33(2):133–137. doi: 10.1016/s0378-5122(99)00057-2. [DOI] [PubMed] [Google Scholar]
  21. Robbins J., Hirsch C., Whitmer R., Cauley J., Harris T. The association of bone mineral density and depression in an older population. J Am Geriatr Soc. 2001 Jun;49(6):732–736. doi: 10.1046/j.1532-5415.2001.49149.x. [DOI] [PubMed] [Google Scholar]
  22. Schoenborn C. A., Horm J. Negative moods as correlates of smoking and heavier drinking: implications for health promotion. Adv Data. 1993 Nov 4;(236):1–16. [PubMed] [Google Scholar]
  23. Schweiger U., Deuschle M., Körner A., Lammers C. H., Schmider J., Gotthardt U., Holsboer F., Heuser I. Low lumbar bone mineral density in patients with major depression. Am J Psychiatry. 1994 Nov;151(11):1691–1693. doi: 10.1176/ajp.151.11.1691. [DOI] [PubMed] [Google Scholar]
  24. Schweiger U., Weber B., Deuschle M., Heuser I. Lumbar bone mineral density in patients with major depression: evidence of increased bone loss at follow-up. Am J Psychiatry. 2000 Jan;157(1):118–120. doi: 10.1176/ajp.157.1.118. [DOI] [PubMed] [Google Scholar]
  25. Simonsick E. M. Personal health habits and mental health in a national probability sample. Am J Prev Med. 1991 Nov-Dec;7(6):425–437. [PubMed] [Google Scholar]
  26. Whooley M. A., Kip K. E., Cauley J. A., Ensrud K. E., Nevitt M. C., Browner W. S. Depression, falls, and risk of fracture in older women. Study of Osteoporotic Fractures Research Group. Arch Intern Med. 1999 Mar 8;159(5):484–490. doi: 10.1001/archinte.159.5.484. [DOI] [PubMed] [Google Scholar]
  27. Yazici Kâzim M., Akinci Ayşen, Sütç Ayşegül, Ozçakar Levent. Bone mineral density in premenopausal women with major depressive disorder. Psychiatry Res. 2003 Mar 25;117(3):271–275. doi: 10.1016/s0165-1781(03)00017-9. [DOI] [PubMed] [Google Scholar]
  28. Zonderman A. B., Costa P. T., Jr, McCrae R. R. Depression as a risk for cancer morbidity and mortality in a nationally representative sample. JAMA. 1989 Sep 1;262(9):1191–1195. [PubMed] [Google Scholar]

Articles from Public Health Reports are provided here courtesy of SAGE Publications

RESOURCES