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The association between depression and bone metabolism: a US nationally representative cross-sectional study

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Abstract

Summary

This population-based study investigated the association between depression and bone mineral density (BMD), fractures, and osteoporosis in the US population. We found that participants with depression had lower BMD and were more likely to have fractures and osteoporosis.

Background

Depression, fractures, and osteoporosis are common in middle-aged and elderly, but their associations remained unclear.

Objective

To investigate the association between depression and bone mineral density (BMD), osteoporosis, and fracture in a middle-aged and elderly US population.

Methods

A nationally representative cross-sectional study used the National Health and Nutrition Examination Survey (NHANES) datasets. Depression was assessed and stratified using the Patient Health Questionnaire (PHQ-9). The multiple logistic regression models and the logistic binary regression models were used to analyze the association between depression and BMD, fractures, and osteoporosis. Gender, age, race, educational level, poverty ratio, body mass index (BMI), smoke, alcohol use, physical activity, and diabetes were included as covariates. Subgroup analysis was also conducted on gender, age, race, and education level.

Results

In total, 9766 participants were included after a series of exclusions, and 4179 (42.79%) had at least mild depressive symptoms. Compared to the participants without depression, those with depression had a lower total femur, femoral neck, and total spine BMD after adjusting multiple covariates. The multivariable-adjusted logistic binary regression models demonstrated that participants with depression more likely have hip fractures (OR = 1.518, 95% CI: 1.377–2.703, P = 0.000), spine fractures (OR = 1.311, 95% CI: 1.022–1.678, P = 0.030), and osteoporosis (OR = 1.621, 95% CI: 1.388–1.890, P = 0.000). Subgroup analysis revealed that depressed participants who were males, non-Hispanic White, ≤ 70 years, and not highly educated had a lower BMD and easily had osteoporosis.

Conclusion

Depression was associated with lower BMD, particularly in the spine, males, Hispanic-White, and not highly educated populations. Moreover, people with depression were more likely to have fractures and osteoporosis.

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Data availability

The datasets are available on https://www.cdc.gov/nchs/nhanes/index.htm, and further inquiries can be directed to the corresponding authors.

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Acknowledgements

We thank the NHANES Project for providing the data free of charge and all NHANES Project staff and anonymous participants.

Funding

This work was supported by the National Natural Science Foundation of China (81874017, 81960403, and 82060405); the Natural Science Foundation of Gansu Province of China (20JR5RA320); and the Cuiying Scientific and Technological Innovation Program of Lanzhou University Second Hospital (CY2017-ZD02).

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Authors and Affiliations

  1. Department of Orthopedics, Lanzhou University Second Hospital, Lanzhou, China

    Ming Ma, Xiaolong Liu, Gengxin Jia, Zhongcheng Liu, Kun Zhang, Liangzhi He, Bin Geng & Yayi Xia

  2. Orthopaedics Key Laboratory of Gansu Province, Lanzhou University Second Hospital, Lanzhou, China

    Ming Ma, Xiaolong Liu, Gengxin Jia, Zhongcheng Liu, Kun Zhang, Liangzhi He, Bin Geng & Yayi Xia

  3. The Second School of Clinical Medical, Lanzhou University, Lanzhou, China

    Ming Ma, Xiaolong Liu, Gengxin Jia, Zhongcheng Liu, Kun Zhang, Liangzhi He, Bin Geng & Yayi Xia

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Contributions

Ming Ma designed the study and prepared the first draft of the paper. The authors Xiaolong Liu, Gengxin Jia, Zhongcheng Liu, Kun Zhang, and Liangzhi He contributed to the analysis work. The authors Bin Geng and Yayi Xia administrated, reviewed, edited, and supervised this work. All authors revised the paper critically for intellectual content and approved the final version. All authors agree to be accountable for the work and ensure that any questions relating to the accuracy and integrity of the paper are investigated and properly resolved. Ming Ma, Xiaolong Liu, and Gengxin Jia friendly shared the first authorship.

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Correspondence to Yayi Xia.

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The National Center for Health Statistics (NCHS) Research Ethics Review Board (ERB) approved this study. Participants were voluntary, confidential, and signed the informed consent form. Further information can be found at https://www.cdc.gov/nchs/nhanes/irba98.htm.

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Ma, M., Liu, X., Jia, G. et al. The association between depression and bone metabolism: a US nationally representative cross-sectional study. Arch Osteoporos 17, 113 (2022). https://doi.org/10.1007/s11657-022-01154-1

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