Depressive symptoms and incident osteoporosis: Findings from a 20-year follow up of the English Longitudinal Study of Ageing
Discuss this preprint
Start a discussion What are Sciety discussions?Listed in
This article is not in any list yet, why not save it to one of your lists.Abstract
Purpose
Psychosocial factors are underexplored in relation to osteoporosis. This study examined whether depressive symptoms are associated with incident osteoporosis in middle aged and older adults, and whether this association is modified by age or sex.
Methods
Prospective cohort study of 8,577 adults aged ≥50 years from the English Longitudinal Study of Ageing. The sample were free of osteoporosis at baseline (2002–2003) and were followed up for incident osteoporosis until wave 11 (2023–2024). Depressive symptoms were measured at baseline (2002-03) using the 8-item Center for Epidemiologic Studies-Depression Scale (CES-D). Cox proportional hazards regressions were used to estimate associations, adjusting for age, sex and wealth.
Results
Over 20 years of follow-up, 948 (11.1%) participants reported incident osteoporosis. Each one-point increase in baseline CES-D was associated with a higher hazard of incident osteoporosis adjusted for age, sex, and wealth (hazard ratio (HR) 1.07, 95% CI 1.04–1.11, p <0.001). The association was modified by age (interaction p =0.008) and concentrated in participants aged 50–64 years at baseline (HR 1.10, 95% CI 1.06–1.14), with no significant association in older age strata. Osteoporosis incidence was higher in women, but this was not modified by depressive symptoms. Findings were robust to sequential adjustment (informed by a directed acyclic graph) for education, wealth, inflammatory conditions and health behaviours (HR 1.04, 95% CI 1.01-1.08)
Conclusion
Depressive symptoms are associated with incident osteoporosis over two decades of follow-up, particularly among adults aged 50–64. Mid-life may represent a target for psychosocial intervention to support bone health.
Mini abstract
Depressive symptoms are a plausible psychosocial risk factor for osteoporosis, but longitudinal evidence is scarce. In 8,577 adults followed for 20 years, higher depressive symptoms were associated with incident osteoporosis, concentrated in those aged 50 to 64. Mid-life depressive symptoms may be a modifiable target for protecting later bone health.
