Health-Related Quality of Life and Medical Resource Use in Patients with Osteoporosis and Depression: A Cross-Sectional Analysis from the National Health and Nutrition Examination Survey

Abstract

Background: Patients with either osteoporosis or depression are prone to develop other diseases and require more medical resources than do the general population. However, there are no studies on health-related quality of life (HRQoL) and medical resource use by osteoporosis patients with comorbid depression. We conducted this study for clarifying it. Methods: This cross-sectional study from 2005 to 2010 (6 years) analyzed 9776 National Health and Nutrition Examination Survey (NHANES) patients > 40 years old. Each patient was assigned to one of four groups: osteoporosis-positive (+) and depression-positive (+) We used multivariate linear and logistic regression model to analyze the HRQoL and medical resource use between groups. Results: The O + /D + group reported more unhealthy days of physical health, more unhealthy days of mental health, and more inactive days during a specified 30 days. The adjusted odds ratios (AORs) of O + /D + patients who had poor general health (7.40, 95% CI = 4.80-11.40), who needed healthcare (3.25, 95% CI = 2.12-5.00), and who had been hospitalized overnight (2.71, 95% CI = 1.89-3.90) were significantly highest. Conclusions: Low HRQoL was significantly more prevalent in D + /O + patients. We found that depression severity more significantly affected HRQoL than did osteoporosis. However, both diseases significantly increased the risk of high medical resource use. expected to increase in the near future. In the developing world, 2% to 8% of men and 9% to 38% of women had osteoporosis [4].An association between major depressive disorder (MDD) and osteoporosis has been reported: patients with MDD apparently have significantly lower bone mineral density (BMD) [5]. Possible factors of reduced BMD in depression patients are the hypothalamic-pituitary-adrenal (HPA) axis: cortisol, leptin, and immune factor levels; cytokine, vitamin D, and parathyroid hormone levels; gender, lifestyle factors, the effect of antidepressants on BMD, osteoporotic fractures, and other comorbid psychiatric conditions [6]. Depression may increase serum cortisol level via activating the hypothalamic corticotropin-releasing hormone neuron. Hypercortisolemia is considered to be a destructive factor for bone health [6]. Depressed patients may have elevated leptin levels, which cause bone loss and inhibits bone formation via activation of sympathetic systems [7,8]. Depression is associated with immune dysregulation and increased oxidative stress, which stimulates HPA axis and results in hypercortisolemia [9,10]. Besides, depression is associated with lower vitamin D and increased parathyroid hormone levels, which may impact bone remodeling [11]. Antidepressants may interfere with sex hormone production such as androgen, which may decrease bone mass and increase risk of orthostatic hypotension, falls and bone fractures [12][13][14]. The incidence rate of depression or anxiety in women with osteoporosis was 46.8 per 1000 person years in the USA [15]. One study utilized data from US households civilian population from 2007...

Bone Metabolism and Vitamin D Implication in Gastroenteropancreatic Neuroendocrine Tumors

“…However, studies focusing on vitamin D and bone in GEP-NETs are missing. Weak or indirect effects on bone are described for depression, low physical activity, as well as specific miRNAs (miRNA-210, -21 and -196a) [56,57,83,130]. Finally, specific aspects of MEN1 syndrome, including primary HPT and gastrinoma, have been shown to worsen BMD.…”

“…Furthermore, patients with recurrent disease reported significantly higher anxiety, impaired overall physical function, impaired sleep, and significant fatigue compared to those with no current NET [82]. It has been reported that in patients with depressive disorder, the duration of the disease negatively correlates with BMD and physical activity, which, in turn, significantly reduces the HRQoL [83]. Moreover, low physical activity is associated with an increased risk of osteoporosis [84].…”

Big Data, Decision Models, and Public Health

“…However, there are no studies on health-related quality of life (HRQoL) and medical resource use by osteoporosis patients with comorbid depression. The first paper, “ Health-Related Quality of Life and Medical Resource Use in Patients with Osteoporosis and Depression: A Cross-Sectional Analysis from the National Health and Nutrition Examination Survey ”, by Weng et al [ 21 ], uses multivariate linear and logistic regression model to analyze the HRQoL and medical resource use between groups. Each patient was assigned to one of four groups: osteoporosis-positive (+) and depression-positive (+) (O + /D + ); O + /D − ; O − /D + ; O − /D − .…”

Association between bipolar affective disorder, use of antidepressants and osteoporosis

“…Well-known risk factors are: biological predisposition, gender, age, positive family history, low body weight and bad habits (smoking, taking alcohol, fast food, greasy and poor-quality food, lack of physical activity) as well as the use of certain medications (etc. corticosteroids) [6,7]. In addition to those risk factors, it is not clear whether the same pathophysiological processes take place in mood disorders and osteoporosis [1,2].…”

“…Common facts that prove the existence of common pathophysiological processes in both disorders are considered to be hypercortisolemia, increased activity of the hypothalamicpituitary-adrenal axis, increased cytokine activity (interleukin-6 (IL-6) and tumor necrosis factor (TNF)), and decrease in anti-inflammatory interleukin activity (IL-10, IL-13) as well as an increase in oxidative stress factors, increase in parathyroid hormone levels with consecutive decrease of 25 (OH) D vitamin, and the decrease in estrogen levels in plasma [6,[8][9][10][11].…”