Compared with people without osteoporosis, those with osteoporosis were 1.73 times more likely to experience depressive symptoms and almost twice as likely to have depression.

Osteoporosis is an independent risk factor for depression, according to a new study published in Public Health. The lack of physical activity, chronic pain, and risk of fractures can greatly limit the social activities of older people with osteoporosis, putting them at risk for mental health issues, noted the authors. The results of this study highlight the “need to evaluate the mental well-being of patients with osteoporosis in clinical and primary health care.”

The global prevalence of osteoporosis is rising. According to the Centers for Disease Control and Prevention, the age-adjusted prevalence of osteoporosis and adults aged 50 and older was 12.5%, with women more affected than men (19.6% of women compared with 4.4% of men).  Yet it has been unclear whether people with osteoporosis have a higher risk of depression than those without osteoporosis.

To evaluated whether patients with osteoporosis are at higher risk of depression, the authors used data from the National Health and Nutrition Examination Survey (NHANES) from  2005-2006, 2007-2008, 2009-2010, 2013-2014, and 2017-2020. The diagnosis of osteoporosis was based on the bone mineral density of the femoral neck, as measured by dual-energy x-ray absorptiometry. Depression was assessed by the Patient Health Questionnaire-9 (PHQ-9), with a score of 5 or greater indicating depressive symptoms and a score 10 or greater as probable depression.

A total of 11,603 adults (52.3% male) were included in the study. Of those, 5.2% were diagnosed with osteoporosis; 31.9% of these osteoporotic patients had depressive symptoms, and 10% had probable depression. Participants with osteoporosis were more likely to be older (70.9 years vs 62.6 years, P <0.001), female (84.6% vs 49.4%, P <0.001), non-Hispanic white (83.2% vs 75.9%, P <0.001), and current smokers (19.6% vs 15.1%, P <0.001). Patients with osteoporosis were less likely to be overweight (BMI ≥25 kg/m² [41.7% vs 75.3%, P <0.001]); less likely to have an education level higher than college graduate or above (49.6% vs 58.8%, P <0.001); and less likely to be married or living with someone as if married (48.1% vs 68.0%, P <0.001).

“Compared to participants without osteoporosis, those with osteoporosis were 1.73 times more likely to experience depressive symptoms (odds ratio [OR] = 1.73, 95% confidence interval [CI] 1.20–2.50) and 1.91 times more likely to experience probable depression (OR=1.91, 95% CI 1.02–3.59), after adjusting for sex, age, race/ethnicity, education, marital status, family income, body mass index, smoking, physical activity, and alcohol abuse,” wrote the authors.

“The good news is that moderate-to-vigorous activities ‘mediated the association between osteoporosis and depression and depressive symptoms.’”

The authors reported that many of the people with osteoporosis would avoid moderate-to-vigorous physical activity because of their fear of falls or fractures. This lack of physical activity can increase the risk of depression. 

The good news is that moderate-to-vigorous activities “mediated the association between osteoporosis and depression and depressive symptoms,” noted the authors. “Our findings indicated the necessity to evaluate and take care of mental health for older adults with osteoporosis to improve their life quality and diminish disease burden.”