Depression and fractures

Townsend Letter for Doctors and Patients,  April, 2005  by Robert A. Anderson

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In 1,150 female and male distal forearm fracture cases and 2,331 controls age [greater than or equal to]45, previous fractures since age 45 were associated with a 5-year adjusted odds ratio of 1.48 per previous fracture (95% CI 1.20-1.84). Factors reducing risk for second fractures included:

* current use of hormone replacement therapy (adjusted OR 0.60 [0.49-0.74])

* high body mass index (adjusted OR 0.96 [NS] per 5 unit increase)

* high dietary calcium intake (adjusted OR 0.88 [NS] per 500 mg/d).

Factors increasing risk included:

* falls in the past year and conditions associated with falling (e.g. epilepsy) (adjusted OR 2.07 [1.35-3.17])

* history of diagnosed depression (adjusted OR 1.40 [1.13-1.73]).

Data indicated that distal forearm fractures tended to occur in people with low bone mass who are otherwise in relatively good health and were physically active, and who were prone to falling.

Kelsey JL, Prill MM, Keegan TH et al. Reducing the risk for distal forearm fracture: preserve bone mass, slow down, and don't fall! Osteoporos Int 2004 Oct 26; [Epub ahead of print]

Comment: The relevance of this study is the 40% increased risk in depressed patients. The postulated mechanism is not discussed by the authors. It could be as simple as the fact that depressed people may be prone to being more careless about taking risks associated with falls. It is also likely, based on the studies cited above, that depression is associated with a cascade of biochemical changes including release of increased amounts of cytokines which have as one of their effects the osteoclastosis of bone. Measures to decrease frequency of falls and to slow down the pace of relatively healthy people with low bone mass could obviously lead to a lower frequency of distal forearm fracture. Seen through a wider lens, appropriate identification and treatment of depression could also lessen risk.

COPYRIGHT 2005 The Townsend Letter Group
COPYRIGHT 2005 Gale Group