Wu Shuang, Shi Hui, Cheng Rui, Xiang Zhou, Huang Shi-Shu
Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu 610000, China.
Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA 15260, USA.
Bone. 2022 Jun;159:116374. doi: 10.1016/j.bone.2022.116374. Epub 2022 Feb 25.
The presence of depressive symptoms is associated with increasing risks of hip fractures (HFs). However, few studies investigated the longitudinal relationship between depressive symptoms and incident HFs among Chinese older adults, and the underlying mechanisms remain unclear.
To investigate the association between depressive symptoms and incident HFs, and the mediating role of cognitive function and impairment in activities of daily living (ADL) in the association among the older adults in China.
This population-based cohort study included 6336 Chinese older adults (age range, 60-101 years) without the history of HFs at baseline and with complete data during the follow-up. Discrete-time Cox regression was used to evaluate the relationship between depressive symptoms and incident HFs, and bootstrapped multiple mediation analyses were conducted to examine the effects of cognitive function and ADL impairment on the association.
Among 6336 participants (3172 women [50.1%]; mean [SD] age, 67.9 [6.6] years), 264 (4.2%) subjects had HFs onset. After adjusting for age, sex, education, marital status, current residence, smoking status, drinking status, body mass index, number of chronic conditions, and falls history, elevated depressive symptoms were independently associated with increasing risks of HFs (adjusted hazard ratio [aHR]: 1.42; 95% CI: 1.07 to 1.88). However, this association was no longer significant (aHR: 1.09; 95% CI: 0.78 to 1.53) after adjusting for cognitive function and ADL impairment. When mortality and incident HFs were modeled as a composite outcome, the association between depressive symptoms and combined outcomes also remained non-significant after adjusting for cognitive function and ADL impairment. Furthermore, the mediation model demonstrated that cognitive decline (indirect effect: β = 0.002, 95% CI: 0.001 to 0.003) and ADL impairment (indirect effect: β = 0.002, 95% CI: 0.000 to 0.003) fully mediated the association between depressive symptoms and incident HFs after adjusting for age, sex, falls history, and number of chronic conditions.
The positive association between depressive symptoms and incident HFs was confirmed among Chinese older adults, which was fully mediated by cognitive decline and ADL impairment. This study shed new light on the potential role played by depressive symptoms in incident HFs.
抑郁症状的存在与髋部骨折（HF）风险增加相关。然而，很少有研究调查中国老年人中抑郁症状与新发HF之间的纵向关系，其潜在机制仍不清楚。
探讨中国老年人中抑郁症状与新发HF之间的关联，以及认知功能和日常生活活动（ADL）受损在该关联中的中介作用。
这项基于人群的队列研究纳入了6336名中国老年人（年龄范围60 - 101岁），他们在基线时无HF病史且随访期间数据完整。采用离散时间Cox回归评估抑郁症状与新发HF之间的关系，并进行自抽样多重中介分析以检验认知功能和ADL受损对该关联的影响。
在6336名参与者中（3172名女性[50.1%]；平均[标准差]年龄67.9[6.6]岁），264名（4.2%）受试者发生HF。在调整年龄、性别、教育程度（学历）、婚姻状况、当前居住地、吸烟状况、饮酒状况、体重指数、慢性病数量和跌倒史后，抑郁症状加重与HF风险增加独立相关（调整后风险比[aHR]：1.42；95%置信区间[CI]：1.07至1.88）。然而，在调整认知功能和ADL受损后，这种关联不再显著（aHR：1.09；95%CI：0.78至1.53）。当将死亡率和新发HF作为复合结局建模时，在调整认知功能和ADL受损后，抑郁症状与复合结局之间的关联也仍不显著。此外，中介模型表明，在调整年龄、性别、跌倒史和慢性病数量后，认知功能下降（间接效应：β = 0.002，95%CI：0.001至0.003）和ADL受损（间接效应：β = 0.002，95%CI：0.000至0.003）完全介导了抑郁症状与新发HF之间的关联。
在中国老年人中证实了抑郁症状与新发HF之间的正相关，且该关联完全由认知功能下降和ADL受损介导。本研究为抑郁症状在新发HF中所起的潜在作用提供了新的见解。
