Depressive symptoms, bone loss, and fractures in postmenopausal women

Leslie Spangler, Delia Scholes, Robert L. Brunner, John A Robbins, Susan D. Reed, Katherine M. Newton, Jennifer L. Melville, Andrea Z. Lacroix

Research output: Contribution to journalArticlepeer-review

104 Scopus citations


BACKGROUND: Osteoporosis and depression may be associated through common physiologic systems or risk factors. OBJECTIVE: To assess the associations between depressive symptoms (Burnam's scale) or antidepressant use and bone outcomes. DESIGN: Prospective cohort study. PARTICIPANTS: A total of 93,676 postmenopausal women (50 to 79 years old) enrolled in the Women's Health Initiative Observational Study. MEASUREMENTS: Self-reported fractures (n=14,982) (hip [adjudicated], spine, wrist, and "other"). Analyses included 82,410 women with complete information followed on average for 7.4 years. Bone mineral density (BMD) of the hip (n=4539), spine (n=4417), and whole body (n=4502) was measured at baseline and 3 years in women enrolled at 3 densitometry study sites. RESULTS: Overall, there were no statistically significant associations between depressive symptoms or antidepressant therapy and 3-year change in BMD. In a subset of women not using antidepressants, there was a significant difference in whole-body BMD change between women with and without depressive symptoms (P=.05). Depressive symptoms (hazard ratio [HR] 1.08; 95% CI=1.02 to 1.14) and antidepressant therapy (HR=1.22; CI=1.15 to 1.30) independently increased risk of any fracture, the majority of which occurred at "other" anatomic sites. Antidepressant therapy increased the risk of spine fracture (HR=1.36; CI=1.14 to 1.63). No associations were observed between depressive symptoms or antidepressant therapy and hip or wrist fracture. CONCLUSION: In this study of postmenopausal women, average age 64, we observed minimal association between depressive symptoms and 3-year changes in either BMD or fracture risk. Antidepressant use was not associated with changes in BMD, but was associated with increased risk of fractures at the spine and "other " anatomic sites.

Original languageEnglish (US)
Pages (from-to)567-574
Number of pages8
JournalJournal of General Internal Medicine
Issue number5
StatePublished - May 2008


  • Antidepressants
  • Bone density
  • Depressive symptoms
  • Fractures
  • Prospective

ASJC Scopus subject areas

  • Internal Medicine
  • Medicine(all)


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