Are older women with depression at increased risk of falls and fractures?

Hip fracture is more common in depressed elderly people. That is why being elderly and depressed and lonely significantly increases the chances that you will break bones if you fall over, suggests a large study published in the March 8 issue of the Archives of Internal Medicine.

Menopause Depression

Former studies have advised that depression is related with low bone mineral density, and it is widely accepted that low bone mineral density leads to weaker bones. Until now, nonetheless, depression was never directly linked to an increased risk of fracture.

The doctors conducted a prospective investigation 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.

The doctors measured bone mineral density (BMD) in the spine and at the second visit, an asked participants about incident falls (yes/no) at 4 follow-up visits. Nonvertebral ruptures were ascertained for an average of 6 years following the depression measure, and demonstrated radiologically. We determined incident vertebral fractures by comparing lateral spine films took at the first visit (1986-1988) with repeat films obtained an average of 3.7 years.

Contradictory to earlier discoveries, the study exposed no differences in average bone mineral density between depressed and nondepressed women. Even without a variation in bone density, nevertheless, depressed women were at greater threat for break. “This investigation highlights the severe disabilities related with depression,” said principal investigator Mary A. Whooley, SFVAMC staff physician and UCSF assistant professor of medicine. "Better diagnosis and rehabilitation of depression may direct to decreased fracture”, she added.

Poor diet harms bones

Reduced diet is a well-known contributory factor to osteoporosis, or brittle bone disease, in elderly. But it is likely, as other researches have recommended, that increased levels of the hormone produced by stress, cortisol, could negatively affect bone tissue.

Over three years, 329 of them experienced a hip fracture, and they were all asked questions connecting to loneliness, life satisfaction, sleep disorders, anxiety and general mood. Traditional factors known to augment the risk that falling will break a hip, such as body weight, smoking, inactivity and other illness were taken into account. Elderly people are falling down like ninepins, but injury rates are quite small, in terms of actually getting serious injury like a broken hip. It is possible that depressed people are not looking after their diet as well, and this is contributing to osteoporosis."

Although they found an increased risk of falls in depressed, compared with nondepressed, older women, the greater number of falls only partially accounted for the increased risk of fracture among women with depression. "Why women with depression have an increased risk of fracture is not yet clear," the investigators said. The researchers indicated, however, that depression may be related with fractures through other mechanisms such as subsequent decline in physical function.