Risk of Vertebral Fracture in Patients Diagnosed with a Depressive Disorder: A Nationwide Population-Based Cohort Study

Abstract

OBJECTIVE:Previous studies have reported that depression may play a crucial role in the occurrence of vertebral fractures. However, a clear correlation between depressive disorders and osteoporotic fractures has not been established. We explored the association between depressive disorders and subsequent new-onset vertebral fractures. Additionally, we aimed to identify the potential risk factors for vertebral fracture in patients with a depressive disorder.METHODS:We studied patients listed in the Taiwan National Health Insurance Research Database who were diagnosed with a depressive disorder by a psychiatrist. The comparison cohort consisted of age- and sex-matched patients without a depressive disorder. The incidence rate and hazard ratios of subsequent vertebral fracture were evaluated. We used Cox regression analysis to evaluate the risk of vertebral fracture among patients with a depressive disorder.RESULTS:The total number of patients with and without a depressive disorder was 44,812. The incidence risk ratio (IRR) between these 2 cohorts indicated that depressive disorder patients had a higher risk of developing a subsequent vertebral fracture (IRR=1.41, 95% confidence interval [CI]=1.26–1.57, p<0.001). In the multivariate analysis, the depressive disorder cohort showed a higher risk of vertebral fracture than the comparison cohort (adjusted hazard ratio=1.24, 95% CI=1.11–1.38, p<0.001). Being older than 50 years, having a lower monthly income, and having hypertension, diabetes mellitus, cerebrovascular disease, chronic obstructive pulmonary disease, autoimmune disease, or osteoporosis were considered predictive factors for vertebral fracture in patients with depressive disorders.CONCLUSIONS:Depressive disorders may increase the risk of a subsequent new-onset vertebral fracture.

Association between depression and the risk for fracture: a meta-analysis and systematic review

“…Of the 16 studies, most were from America (eight studies) or European countries (five studies). Meanwhile, one study was conducted in Australia [ 20 ] and two in Taiwan [ 8 , 21 ]. Nine studies comprised both men and women, with four reporting results that were based on sex group, two studies included men only [ 22 , 23 ], and five studies involved only women [ 20 , 24 – 27 ].…”

“…Nine studies comprised both men and women, with four reporting results that were based on sex group, two studies included men only [ 22 , 23 ], and five studies involved only women [ 20 , 24 – 27 ]. In most of the studies, depression was assessed using self-reported symptom scales, and in three studies, the condition was confirmed based on the physician’s diagnosis [ 8 , 21 , 28 ]. With regard to fracture types, only five studies reported about any fracture [ 7 , 20 , 23 , 26 , 29 ], and only four studies were about hip fracture [ 8 , 9 , 27 , 30 ].…”

“…With regard to fracture types, only five studies reported about any fracture [ 7 , 20 , 23 , 26 , 29 ], and only four studies were about hip fracture [ 8 , 9 , 27 , 30 ]. Moreover, only two studies reported about nonvertebral fracture [ 22 , 31 ], and one on vertebral fracture [ 21 ]. The remaining four studies were about two or more types of fracture [ 24 , 25 , 28 , 32 ].…”

Elucidating the Mechanism(s) Underlying Antipsychotic- and Antidepressant-Mediated Fractures

“…Reduced bone mass, especially osteoporosis, is significantly more common in people with schizophrenia, bipolar disorder, and depression than controls [9][10][11] . Genetic framework and the use of psychotropic medications play a major role in the preeminent risk of physical morbidity and mortality related to these disorders, including metabolic disorders, endocrine diseases, and fractures.…”

Depression, Osteoporose, Stürze und Frakturen

“…Die Assoziation zwischen Depression und Fraktur wurde nicht nur für Hüftfrakturen, sondern z. B. auch für vertebrale Frakturen beschrieben [6,7].…”