May 7, 1999

Psychiatrists are well aware that depression is a seriously underrecognized and undertreated disorder among the elderly. Now researchers have discovered yet another reason it is critical that elderly persons receive treatment for their depression.

Data from a new multicenter study show that women who are aged 65 or older suffer more falls and a far greater rate of vertebral and other bone fractures-at least 40 percent higher-than their nondepressed counterparts.

Researchers from the University of California at San Francisco, University of Maryland, University of Minnesota, University of Pittsburgh, and Kaiser Permanente Center for Health Research in Portland, Ore., assessed 7,414 white women at least 65 years old for depression, bone mineral density, falls, and fractures. They followed the women for an average of six years.

The researchers assessed the women for depression using the 15-item Geriatric Depression Scale (GDS), with responses to six to 10 symptom questions being categorized as mild to moderate depression and scores of 11 or higher as severe depression.

They report in the March 8 issue of the Archives of Internal Medicine that not only were the 6.3 percent of subjects who were depressed more prone to falls, but also they were twice as likely to suffer vertebral fractures and 40 percent more likely to fracture other bones.

When the researchers accounted for confounding variables such as past physical illnesses, tobacco or alcohol use, and normal level of physical activity, there was still a 30 percent greater risk of breaking bones when a woman was depressed. They also found that use of sedatives/hypnotics or antidepressants was not linked with the probability of broken bones.

Analyzing the specific depression-related factors from the GDS to see whether any appeared to confer a greater risk of bone fractures among elderly women, the researchers found the strongest links with feelings of hopelessness, worthlessness, and dissatisfaction. No association appeared between fractures and lack of energy, feeling in poor spirits, or preferring to stay at home.

They add a caution that since they did not conduct clinical interviews to confirm depression diagnoses, they can "only conclude that depressive symptoms, and not necessarily the clinical diagnosis of depression, are associated with falls and fractures." Despite this possible limitation, they emphasize that their data "highlight the severe disabilities associated with depression," particularly when so many depressed elderly persons fail to receive treatment for their illness.

The Web address for the Archives of Internal Medicine is www.ama-assn.org/internal.