Deakin University, School of Medicine, IMPACT Strategic Research Centre, Geelong, Australia.
Deakin University, School of Medicine, IMPACT Strategic Research Centre, Geelong, Australia; The University of Melbourne, Department of Medicine, St Albans, Australia.
J Affect Disord. 2016 Mar 1;192:34-40. doi: 10.1016/j.jad.2015.11.048. Epub 2015 Dec 10.
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.
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.
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).
Potential limitations include recall bias, unrecognised confounding and generalizability.
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.
先前的研究表明，抑郁症患者的骨密度（BMD）存在缺陷。虽然 BMD 降低是骨折的已知风险，但抑郁症与骨折风险之间的直接联系尚未得到证实。
使用嵌套病例对照和回顾性队列研究设计，对参与 Geelong 骨质疏松研究的女性进行了基于人群的样本研究。使用半结构化临床访谈（SCID-I/NP）确定终生抑郁症病史。通过放射报告确定骨折事件，并使用双能吸收法测量股骨颈处的 BMD。测量人体测量学指标，并通过问卷获取药物使用和生活方式因素的信息。
在 179 例发生骨折的病例和 914 例对照中，抑郁症与骨折的几率增加相关（调整后的比值比（OR）为 1.57，95%CI 为 1.04-2.38）；进一步调整精神药物使用似乎减弱了这种关联（调整后的 OR 为 1.52，95%CI 为 0.98-2.36）。在基线时有抑郁症病史的 165 名女性和没有抑郁症病史的 693 名女性中，抑郁症与新发骨折的风险增加 68%相关（调整后的风险比（HR）为 1.68，95%CI 为 1.02-2.76），进一步调整精神药物使用也似乎减弱了这种关联（调整后的 HR 为 1.58，95%CI 为 0.95-2.61）。
潜在的局限性包括回忆偏倚、未识别的混杂因素和普遍性。
这项研究提供了横断面和纵向证据，表明临床抑郁症是放射确诊的骨折事件的危险因素，与许多已知的危险因素无关。如果精神和骨骼健康之间确实存在临床上有意义的合并症，且可能因精神药物而恶化，那么对高危人群进行筛查的问题需要成为优先事项。
