The relationship between the severity of depression in postmenopausal women and the incidence of osteoporosis and subsequent fractures: A cross-sectional observational study

Postmenopausal women experience declining estrogen levels that create a close association between the incidence of osteoporosis and osteoporotic fractures and the severity of depression, with recent evidence suggesting that depression may further exacerbate bone loss and fracture risk through influences on bone metabolism, lifestyle factors, and medication adherence. To evaluate the relationship between depression severity, bone mineral density, and fracture events, we conducted a combined cross-sectional and prospective cohort study of 245 postmenopausal women. Depression severity was measured using the HAMD-17 scale, bone mineral density was assessed by dual-energy X-ray absorptiometry, and fracture events were confirmed radiographically. Participants were stratified by age, menopause age, body mass index, smoking history, previous fracture history, and comorbidities to assess the impact of depression severity on osteoporosis and fracture risk. Our results demonstrated that depression severity showed significant inverse correlations with lumbar spine bone mineral density (odds ratio = 0.55, 95% confidence interval: 0.40-0.76, P < .001) and hip bone mineral density (odds ratio = 0.68, 95% confidence interval: 0.52-0.89, P < .005), and was positively associated with the incidence of osteoporotic fractures (odds ratio = 3.42, 95% confidence interval: 2.58-4.53, P < .001). Multivariate logistic regression confirmed that depression severity was independently associated with osteoporosis (odds ratio = 2.85, 95% confidence interval: 2.12-3.82, P < .001), while Cox regression analysis showed that it significantly increased fracture risk (hazard ratio = 2.90, 95% confidence interval: 2.10-4.00, P < .001). Subgroup analyses revealed more pronounced associations in women with longer postmenopausal duration exceeding 5 years, lower body mass index below 24 kg/m2, and those with comorbid diabetes. These findings indicate that depression severity in postmenopausal women is significantly associated with reduced bone density, increased prevalence of osteoporosis, and higher fracture rates, offering new strategies for managing the comorbidity of depression and osteoporosis in this population and highlighting the necessity for integrated mental and skeletal health interventions.