Association between mild depressive symptoms and annual changes in bone mineral density among South Korean women: a retrospective study

Background: Depression is associated with various physical conditions, including bone metabolism. Most previous studies were cross-sectional, and longitudinal findings regarding osteoporosis or fracture risk remain inconsistent. This study examined the association between mild depressive symptoms and annual changes in bone mineral density (BMD) among women undergoing repeated dual-energy X-ray absorptiometry (DEXA). Methods: We retrospectively analyzed 1,629 women aged ≥20 years who completed the Patient Health Questionnaire-9 (PHQ-9) and underwent at least two DEXA scans between 2017 and 2023. Mild depressive symptoms were defined as PHQ-9 scores of 5-9. Annualized BMD changes at the lumbar spine, femoral neck, and total femur were calculated. Multivariable linear regression analyses adjusted for age, body mass index, smoking, alcohol consumption, physical activity, and diabetes. Women with PHQ-9 ≥10, only one DEXA scan, T-score ≤-2.5, or missing PHQ-9 data were excluded. Results: Mild depressive symptoms were not significantly associated with annualized BMD change in the overall cohort. However, among women aged ≥60 years (n=1,047), PHQ-9 scores of 5-9 were associated with more negative annualized BMD changes at the femoral neck (β=-3.26; 95% confidence interval [CI], -5.92 to -0.61; P=0.016) and total femur (β=-2.24; 95% CI, -4.39 to -0.09; P=0.041), but not at the lumbar spine. Conclusion: In women aged ≥60 years, mild depressive symptoms were negatively associated with annual BMD change. Given the close relationship between femoral BMD and hip fracture, even modest negative shifts may be clinically meaningful in older women.