CLINICS

Clinics (Sao Paulo). 2017 January; 72(1): 44-50.
doi:10.6061/clinics/2017(01)08

Copyright © 2017 CLINICS

Risk of Vertebral Fracture in Patients Diagnosed with a Depressive Disorder: A Nationwide Population-Based Cohort Study

Shyh-Chyang Lee II # , Li-Yu Hu I III # , Min-Wei Huang IV , Cheng-Che Shen III IV V , Wei-Lun Huang VI , Ti Lu I , Chiao-Lin Hsu VII VIII * , Chih-Chuan Pan I *

Kaohsiung Veterans General Hospital, Department of Psychiatry, Kaohsiung, Taiwan.

Taichung Veterans General Hospital, Department of Orthopedics, Chiayi Branch, Chiayi, Taiwan.

National Yang-Ming University, Faculty of Medicine, Division of Psychiatry, Taipei, Taiwan.

Taichung Veterans General Hospital, Department of Psychiatry, Chiayi Branch, Chiayi, Taiwan.

National Chung-Cheng University, Department of Information Management, Chiayi, Taiwan.

Taipei Veteran General Hospital, Department of Family Medicine, Taitung Branch, Taitung, Taiwan

Kaohsiung Veterans General Hospital, Department of Family Medicine, Kaohsiung, Taiwan.

Kaohsiung Veterans General Hospital, Physical Examination Center, Kaohsiung, Taiwan.

*Corresponding author. E-mail: jolindr0610@gmail.com / ccpan@vghks.gov.tw

# Contributed equally to this manuscript.

received July 20, 2016; revised October 26, 2016; accepted October 26, 2016.

Abstract

OBJECTIVE:

Previous studies have reported that depression may play a crucial role in the occurrence of vertebral fractures. However, a clear correlation between depressive disorders and osteoporotic fractures has not been established. We explored the association between depressive disorders and subsequent new-onset vertebral fractures. Additionally, we aimed to identify the potential risk factors for vertebral fracture in patients with a depressive disorder.

METHODS:

We studied patients listed in the Taiwan National Health Insurance Research Database who were diagnosed with a depressive disorder by a psychiatrist. The comparison cohort consisted of age- and sex-matched patients without a depressive disorder. The incidence rate and hazard ratios of subsequent vertebral fracture were evaluated. We used Cox regression analysis to evaluate the risk of vertebral fracture among patients with a depressive disorder.

RESULTS:

The total number of patients with and without a depressive disorder was 44,812. The incidence risk ratio (IRR) between these 2 cohorts indicated that depressive disorder patients had a higher risk of developing a subsequent vertebral fracture (IRR=1.41, 95% confidence interval [CI]=1.26–1.57, p<0.001). In the multivariate analysis, the depressive disorder cohort showed a higher risk of vertebral fracture than the comparison cohort (adjusted hazard ratio=1.24, 95% CI=1.11–1.38, p<0.001). Being older than 50 years, having a lower monthly income, and having hypertension, diabetes mellitus, cerebrovascular disease, chronic obstructive pulmonary disease, autoimmune disease, or osteoporosis were considered predictive factors for vertebral fracture in patients with depressive disorders.

CONCLUSIONS:

Depressive disorders may increase the risk of a subsequent new-onset vertebral fracture.

Keywords: Depressive Disorder, Osteoporotic Fracture, Vertebral Fracture, Risk Factor


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