Whooley M A, Kip K E, Cauley J A, Ensrud K E, Nevitt M C, Browner W S
San Francisco Department of Veterans Affairs Medical Center and the Department of Medicine, University of California 94121, USA.
Arch Intern Med. 1999 Mar 8;159(5):484-90. doi: 10.1001/archinte.159.5.484.
Previous studies have suggested that depression is associated with falls and with low bone density, but it is not known whether depression leads to an increased risk of fracture.
We conducted a prospective cohort study in elderly white women who were recruited from population-based listings in the United States. At a second visit (1988-1990), 7414 participants completed the 15-item Geriatric Depression Scale and were considered depressed if they reported 6 or more symptoms of depression. We measured bone mineral density (BMD) in the spine and hip using dual energy x-ray absorptiometry at the second visit, and asked participants about incident falls (yes/no) at 4 follow-up visits. Nonvertebral fractures were ascertained for an average of 6 years following the depression measure, and verified radiologically. We determined incident vertebral fractures by comparing lateral spine films obtained at the first visit (1986-1988) with repeat films obtained an average of 3.7 years later (1991-1992).
The prevalence of depression (Geriatric Depression Scale score > or = 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 without depression. Women with depression were more likely to experience subsequent falls than women without depression (70% vs 59%; age-adjusted odds ratio [OR], 1.6; 95% confidence interval [CI], 1.3-1.9; P<.001), an association that persisted after adjusting for potential confounding 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 depression (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 appeared 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 without depression, adjusting for history of vertebral fracture, history of falling, arthritis, diabetes, steroid use, estrogen use, supplemental calcium use, cognitive function, and hip BMD (OR, 2.1; 95% CI, 1.4-3.2; P<.001).
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 association between depression and fracture remain to be determined.
先前的研究表明，抑郁症与跌倒及低骨密度相关，但抑郁症是否会导致骨折风险增加尚不清楚。
我们在美国从基于人群的名单中招募老年白人女性进行了一项前瞻性队列研究。在第二次就诊时（1988 - 1990年），7414名参与者完成了15项老年抑郁量表调查，如果她们报告有6种或更多抑郁症状则被视为患有抑郁症。在第二次就诊时，我们使用双能X线吸收法测量了脊柱和髋部的骨密度，并在4次随访中询问参与者是否发生过跌倒（是/否）。在抑郁症测量后的平均6年时间里确定非椎体骨折情况，并通过放射学进行核实。我们通过比较首次就诊时（1986 - 1988年）获得的脊柱侧位片与平均3.7年后（1991 - 1992年）获得的重复片来确定新发椎体骨折情况。
抑郁症（老年抑郁量表评分≥6）的患病率为6.3%（467/7414）。我们发现患有抑郁症的女性与未患抑郁症的女性相比，髋部和腰椎的平均骨密度没有差异。与未患抑郁症的女性相比，患有抑郁症的女性更有可能随后发生跌倒（70%对59%；年龄调整后的优势比[OR]为1.6；95%置信区间[CI]为1.3 - 1.9；P <.001），在调整潜在混杂变量后这种关联仍然存在（OR为1.4；95% CI为1.1 - 1.8；P =.004）。与未患抑郁症的女性相比（在59503人年的随访中有1367例骨折），患有抑郁症的女性非椎体骨折发生率增加了40%（年龄调整后的风险比[HR]为1.4；95% CI为1.2 - 1.7；P <.001）（在3805人年的随访中有124例骨折）。在调整包括药物使用和神经肌肉功能等潜在混杂变量后，这种关联仍然很强（HR为1.3；95% CI为1.1 - 1.6；P =.008）。对随后跌倒情况进行进一步调整似乎可以解释这种关联的一部分（HR为1.2；95% CI为1.0 - 1.5；P =.06）。在调整椎体骨折史、跌倒史、关节炎、糖尿病、类固醇使用、雌激素使用、补充钙使用、认知功能和髋部骨密度后，患有抑郁症的女性也比未患抑郁症的女性更易发生椎体骨折（OR为2.1；95% CI为1.4 - 3.2；P <.001）。
抑郁症是老年女性骨折的一个重要危险因素。抑郁症患者跌倒频率更高部分解释了这一发现。抑郁症与骨折之间关联的其他机制仍有待确定。
