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The association between depression and bone metabolism: a US nationally representative cross-sectional study. Arch Osteoporos 2022; 17:113. [PMID: 35962284 DOI: 10.1007/s11657-022-01154-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 07/26/2022] [Indexed: 02/03/2023]
Abstract
This population-based study investigated the association between depression and bone mineral density (BMD), fractures, and osteoporosis in the US population. We found that participants with depression had lower BMD and were more likely to have fractures and osteoporosis. BACKGROUND Depression, fractures, and osteoporosis are common in middle-aged and elderly, but their associations remained unclear. OBJECTIVE To investigate the association between depression and bone mineral density (BMD), osteoporosis, and fracture in a middle-aged and elderly US population. METHODS A nationally representative cross-sectional study used the National Health and Nutrition Examination Survey (NHANES) datasets. Depression was assessed and stratified using the Patient Health Questionnaire (PHQ-9). The multiple logistic regression models and the logistic binary regression models were used to analyze the association between depression and BMD, fractures, and osteoporosis. Gender, age, race, educational level, poverty ratio, body mass index (BMI), smoke, alcohol use, physical activity, and diabetes were included as covariates. Subgroup analysis was also conducted on gender, age, race, and education level. RESULTS In total, 9766 participants were included after a series of exclusions, and 4179 (42.79%) had at least mild depressive symptoms. Compared to the participants without depression, those with depression had a lower total femur, femoral neck, and total spine BMD after adjusting multiple covariates. The multivariable-adjusted logistic binary regression models demonstrated that participants with depression more likely have hip fractures (OR = 1.518, 95% CI: 1.377-2.703, P = 0.000), spine fractures (OR = 1.311, 95% CI: 1.022-1.678, P = 0.030), and osteoporosis (OR = 1.621, 95% CI: 1.388-1.890, P = 0.000). Subgroup analysis revealed that depressed participants who were males, non-Hispanic White, ≤ 70 years, and not highly educated had a lower BMD and easily had osteoporosis. CONCLUSION Depression was associated with lower BMD, particularly in the spine, males, Hispanic-White, and not highly educated populations. Moreover, people with depression were more likely to have fractures and osteoporosis.
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Zhu C, Yu H, Lian Z, Wang J. Prospective association between depressive symptoms and hip fracture and fall among middle-aged and older Chinese individuals. BMC Psychiatry 2022; 22:258. [PMID: 35413849 PMCID: PMC9004028 DOI: 10.1186/s12888-022-03906-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 04/01/2022] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND The effect of depressive symptoms on hip fracture (HF) and falls among the Chinese population is unclear. This study aims to examine the prospective association between depressive symptoms and HF as well as fall accidents in a nationally representative Chinese population. METHODS We used data from 10,596 participants in the Chinese Health and Retirement Longitudinal Study (from 2011 to 2018) who were aged ≥45 years and had no HFs at baseline. Depressive symptoms were assessed using the 10-item version of the Center for Epidemiological Studied Depression scale (cutoff for distinguishing high versus low at ≥12). Logistic regression analyses adjusted for demographic characteristics, lifestyle factors and physical comorbidities were performed. RESULTS For the analysis of baseline depressive symptoms and HF, 399 (3.8%) participants reported HF accidents in the following 7-year period. Individuals with elevated depressive symptoms at baseline experienced a markedly higher HF risk (odds ratio [OR] = 1.33, 95% confidence interval [CI] = 1.06-1.67) than those without elevated depressive symptoms, after adjusting for a wide range of potential confounders. For the analysis of baseline depressive symptoms and falls, 3974 (37.5%) experienced fall accidents during the follow-up. The presence of elevated depressive symptoms was independently associated with an increased risk of fall events (OR = 1.21, 95% CI = 1.10-1.33). These associations were consistent across multiple characteristics. CONCLUSIONS In conclusion, elevated depressive symptoms were associated with an increased risk of HF and falls, which may have considerable clinical and preventive implications.
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Affiliation(s)
- Chunsu Zhu
- grid.415110.00000 0004 0605 1140Fujian Medical University Cancer Hospital, Fujian Cancer Hospital, No. 420, Fuma Road, Jinan District, Fuzhou, 350014 China
| | - Hongyu Yu
- grid.415110.00000 0004 0605 1140Fujian Medical University Cancer Hospital, Fujian Cancer Hospital, No. 420, Fuma Road, Jinan District, Fuzhou, 350014 China
| | - Zhiwei Lian
- Fujian Medical University Cancer Hospital, Fujian Cancer Hospital, No. 420, Fuma Road, Jinan District, Fuzhou, 350014, China.
| | - Jianmin Wang
- grid.415110.00000 0004 0605 1140Fujian Medical University Cancer Hospital, Fujian Cancer Hospital, No. 420, Fuma Road, Jinan District, Fuzhou, 350014 China
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He B, Lyu Q, Yin L, Zhang M, Quan Z, Ou Y. Depression and Osteoporosis: A Mendelian Randomization Study. Calcif Tissue Int 2021; 109:675-684. [PMID: 34259888 PMCID: PMC8531056 DOI: 10.1007/s00223-021-00886-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 06/29/2021] [Indexed: 12/15/2022]
Abstract
Observational studies suggest a link between depression and osteoporosis, but these may be subject to confounding and reverse causality. In this two-sample Mendelian randomization analysis, we included the large meta-analysis of genome-wide association studies for depression among 807,553 individuals (246,363 cases and 561,190 controls) of European descent, the large meta-analysis to identify genetic variants associated with femoral neck bone mineral density (FN-BMD), forearm BMD (FA-BMD) and lumbar spine BMD (LS-BMD) among 53,236 individuals of European ancestry, and the GWAS summary data of heel BMD (HE-BMD) and fracture among 426,824 individuals of European ancestry. The results revealed that genetic predisposition towards depression showed no causal effect on FA-BMD (beta-estimate: 0.091, 95% confidence interval [CI] - 0.088 to 0.269, SE:0.091, P value = 0.320), FN-BMD (beta-estimate: 0.066, 95% CI - 0.016 to 0.148, SE:0.042, P value = 0.113), LS-BMD (beta-estimate: 0.074, 95% CI - 0.029 to 0.177, SE:0.052, P value = 0.159), HE-BMD (beta-estimate: 0.009, 95% CI - 0.043 to 0.061, SE:0.027, P value = 0.727), or fracture (beta-estimate: 0.008, 95% CI - 0.071 to 0.087, SE:0.041, P value = 0.844). These results were also confirmed by multiple sensitivity analyses. Contrary to the findings of observational studies, our results do not reveal a causal role of depression in osteoporosis or fracture.
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Affiliation(s)
- Bin He
- Department of Orthopedics, The First Affiliated Hospital of Chongqing Medical University, No. 1 Yi Xue Yuan Road, Yuzhong District, Chongqing, 400016, China.
| | - Qiong Lyu
- Department of General Practice, The First Affiliated Hospital of Chongqing Medical University, No. 1 Yi Xue Yuan Road, Yuzhong District, Chongqing, 400016, China
| | - Lifeng Yin
- Department of Orthopedics, The First Affiliated Hospital of Chongqing Medical University, No. 1 Yi Xue Yuan Road, Yuzhong District, Chongqing, 400016, China
| | - Muzi Zhang
- Department of Orthopedics, The First Affiliated Hospital of Chongqing Medical University, No. 1 Yi Xue Yuan Road, Yuzhong District, Chongqing, 400016, China
| | - Zhengxue Quan
- Department of Orthopedics, The First Affiliated Hospital of Chongqing Medical University, No. 1 Yi Xue Yuan Road, Yuzhong District, Chongqing, 400016, China
| | - Yunsheng Ou
- Department of Orthopedics, The First Affiliated Hospital of Chongqing Medical University, No. 1 Yi Xue Yuan Road, Yuzhong District, Chongqing, 400016, China
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Qin HC, Luo ZW, Chou HY, Zhu YL. New-onset depression after hip fracture surgery among older patients: Effects on associated clinical outcomes and what can we do? World J Psychiatry 2021; 11:1129-1146. [PMID: 34888179 PMCID: PMC8613761 DOI: 10.5498/wjp.v11.i11.1129] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 06/25/2021] [Accepted: 08/23/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Hip fracture in the elderly is a worldwide medical problem. New-onset depression after hip fracture has also received attention because of its increasing incidence and negative impact on recovery.
AIM To provide a synthesis of the literature addressing two very important questions arising from postoperative hip fracture depression (PHFD) research: the risk factors and associated clinical outcomes of PHFD, and the optimal options for intervention in PHFD.
METHODS We searched the PubMed, Web of Science, EMBASE, and PsycINFO databases for English papers published from 2000 to 2021.
RESULTS Our results showed that PHFD may result in poor clinical outcomes, such as poor physical function and more medical support. In addition, the risk factors for PHFD were summarized, which made it possible to assess patients preoperatively. Moreover, our work preliminarily suggested that comprehensive care may be the optimal treatment option for PHFDs, while interdisciplinary intervention can also be clinically useful.
CONCLUSION We suggest that clinicians should assess risk factors for PHFDs preoperatively, and future research should further validate current treatment methods in more countries and regions and explore more advanced solutions.
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Affiliation(s)
- Hao-Cheng Qin
- Department of Rehabilitation Medicine, Huashan Hospital, Fudan University, Shanghai 200040, China
| | - Zhi-Wen Luo
- Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai 200040, China
| | - Heng-Yi Chou
- Department of Orthopedics, Huashan Hospital, Fudan University, Shanghai 200040, China
| | - Yu-Lian Zhu
- Department of Rehabilitation Medicine, Huashan Hospital, Fudan University, Shanghai 200040, China
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Chen H, Shang D, Wen Y, Liang C. Bone-Derived Modulators That Regulate Brain Function: Emerging Therapeutic Targets for Neurological Disorders. Front Cell Dev Biol 2021; 9:683457. [PMID: 34179014 PMCID: PMC8222721 DOI: 10.3389/fcell.2021.683457] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Accepted: 05/18/2021] [Indexed: 12/31/2022] Open
Abstract
Bone has traditionally been regarded as a structural organ that supports and protects the various organs of the body. Recent studies suggest that bone also acts as an endocrine organ to regulate whole-body metabolism. Particularly, homeostasis of the bone is shown to be necessary for brain development and function. Abnormal bone metabolism is associated with the onset and progression of neurological disorders. Recently, multiple bone-derived modulators have been shown to participate in brain function and neurological disorders, including osteocalcin, lipocalin 2, and osteopontin, as have bone marrow-derived cells such as mesenchymal stem cells, hematopoietic stem cells, and microglia-like cells. This review summarizes current findings regarding the roles of these bone-derived modulators in the brain, and also follows their involvement in the pathogenesis of neurological disorders. The content of this review may aide in the development of promising therapeutic strategies for neurological disorders via targeting bone.
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Affiliation(s)
- Hongzhen Chen
- Department of Biology, Southern University of Science and Technology, Shenzhen, China.,Department of Pharmacy, The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
| | - Dewei Shang
- Department of Pharmacy, The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
| | - Yuguan Wen
- Department of Pharmacy, The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
| | - Chao Liang
- Department of Biology, Southern University of Science and Technology, Shenzhen, China
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Yang F, Liu Y, Chen S, Dai Z, Yang D, Gao D, Shao J, Wang Y, Wang T, Zhang Z, Zhang L, Lu WW, Li Y, Wang L. A GABAergic neural circuit in the ventromedial hypothalamus mediates chronic stress-induced bone loss. J Clin Invest 2021; 130:6539-6554. [PMID: 32910804 DOI: 10.1172/jci136105] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Accepted: 08/26/2020] [Indexed: 12/25/2022] Open
Abstract
Homeostasis of bone metabolism is regulated by the central nervous system, and mood disorders such as anxiety are associated with bone metabolism abnormalities, yet our understanding of the central neural circuits regulating bone metabolism is limited. Here, we demonstrate that chronic stress in crewmembers resulted in decreased bone density and elevated anxiety in an isolated habitat mimicking a space station. We then used a mouse model to demonstrate that GABAergic neural circuitry in the ventromedial hypothalamus (VMH) mediates chronic stress-induced bone loss. We show that GABAergic inputs in the dorsomedial VMH arise from a specific group of somatostatin neurons in the posterior region of the bed nucleus of the stria terminalis, which is indispensable for stress-induced bone loss and is able to trigger bone loss in the absence of stressors. In addition, the sympathetic system and glutamatergic neurons in the nucleus tractus solitarius were employed to regulate stress-induced bone loss. Our study has therefore identified the central neural mechanism by which chronic stress-induced mood disorders, such as anxiety, influence bone metabolism.
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Affiliation(s)
- Fan Yang
- Brain Cognition and Brain Disease Institute, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences (CAS).,CAS Key Laboratory of Brain Connectome and Manipulation.,Guangdong Provincial Key Laboratory of Brain Connectome and Behavior.,Shenzhen-Hong Kong Institute of Brain Science-Shenzhen Fundamental Research Institutions, Shenzhen, China.,University of Chinese Academy of Sciences, Beijing, China
| | - Yunhui Liu
- Brain Cognition and Brain Disease Institute, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences (CAS).,CAS Key Laboratory of Brain Connectome and Manipulation.,Guangdong Provincial Key Laboratory of Brain Connectome and Behavior.,Shenzhen-Hong Kong Institute of Brain Science-Shenzhen Fundamental Research Institutions, Shenzhen, China.,University of Chinese Academy of Sciences, Beijing, China
| | - Shanping Chen
- Brain Cognition and Brain Disease Institute, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences (CAS).,CAS Key Laboratory of Brain Connectome and Manipulation.,Guangdong Provincial Key Laboratory of Brain Connectome and Behavior.,Shenzhen-Hong Kong Institute of Brain Science-Shenzhen Fundamental Research Institutions, Shenzhen, China.,University of Chinese Academy of Sciences, Beijing, China
| | - Zhongquan Dai
- State Key Laboratory of Space Medicine Fundamentals and Application, China Astronaut Research and Training Center, Beijing, China
| | - Dazhi Yang
- Department of Orthopedics, Union Shenzhen Hospital, Huazhong University of Science and Technology, Shenzhen, China
| | - Dashuang Gao
- Brain Cognition and Brain Disease Institute, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences (CAS).,CAS Key Laboratory of Brain Connectome and Manipulation.,Guangdong Provincial Key Laboratory of Brain Connectome and Behavior.,Shenzhen-Hong Kong Institute of Brain Science-Shenzhen Fundamental Research Institutions, Shenzhen, China.,University of Chinese Academy of Sciences, Beijing, China
| | - Jie Shao
- Brain Cognition and Brain Disease Institute, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences (CAS).,CAS Key Laboratory of Brain Connectome and Manipulation.,Guangdong Provincial Key Laboratory of Brain Connectome and Behavior.,Shenzhen-Hong Kong Institute of Brain Science-Shenzhen Fundamental Research Institutions, Shenzhen, China.,University of Chinese Academy of Sciences, Beijing, China
| | - Yuyao Wang
- Brain Cognition and Brain Disease Institute, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences (CAS).,CAS Key Laboratory of Brain Connectome and Manipulation.,Guangdong Provincial Key Laboratory of Brain Connectome and Behavior.,Shenzhen-Hong Kong Institute of Brain Science-Shenzhen Fundamental Research Institutions, Shenzhen, China
| | - Ting Wang
- Brain Cognition and Brain Disease Institute, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences (CAS).,CAS Key Laboratory of Brain Connectome and Manipulation.,Guangdong Provincial Key Laboratory of Brain Connectome and Behavior.,Shenzhen-Hong Kong Institute of Brain Science-Shenzhen Fundamental Research Institutions, Shenzhen, China
| | - Zhijian Zhang
- Center for Brain Science, Key Laboratory of Magnetic Resonance in Biological Systems and State Key Laboratory of Magnetic Resonance and Atomic and Molecular Physics, Wuhan Institute of Physics and Mathematics, CAS, Wuhan, China.,Center for Excellence in Brain Science and Intelligence Technology, CAS, Shanghai, China
| | - Lu Zhang
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Hong Kong, China
| | - William W Lu
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Hong Kong, China
| | - Yinghui Li
- State Key Laboratory of Space Medicine Fundamentals and Application, China Astronaut Research and Training Center, Beijing, China
| | - Liping Wang
- Brain Cognition and Brain Disease Institute, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences (CAS).,CAS Key Laboratory of Brain Connectome and Manipulation.,Guangdong Provincial Key Laboratory of Brain Connectome and Behavior.,Shenzhen-Hong Kong Institute of Brain Science-Shenzhen Fundamental Research Institutions, Shenzhen, China.,University of Chinese Academy of Sciences, Beijing, China
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Heidari ME, Naghibi Irvani SS, Dalvand P, Khadem M, Eskandari F, Torabi F, Shahsavari H. Prevalence of depression in older people with hip fracture: A systematic review and meta-analysis. Int J Orthop Trauma Nurs 2020; 40:100813. [PMID: 33317987 DOI: 10.1016/j.ijotn.2020.100813] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Revised: 05/29/2020] [Accepted: 07/24/2020] [Indexed: 02/06/2023]
Abstract
INTRODUCTION Hip fracture disrupts general health and is one of the most common physical injuries in the elderly. Depression is the most common mood disorder in older people and one of the main complications of hip fractures. AIM AND METHODS We conducted a meta-analysis to estimate the prevalence of depression in older people with hip fractures. Relevant literature published until July 2019 was obtained and screened according to established inclusion criteria. Two researchers independently carried out quality assessment and data extraction before the meta-analysis. We calculated proportions with 95% confidence intervals (CI). To investigate the sources of heterogeneity, we performed subgroup analyses based on study design, follow-up duration, type of fracture, and gender. RESULTS Twenty-seven studies with a combined sample size of 11958 were included. The overall prevalence of depression in older people with hip fracture was 23% (95% CI: 0.18 to 0.29). The lowest and highest prevalence of depression was in Asia (0.19) and America (0.27) respectively. CONCLUSION In this systematic review and meta-analysis the estimated prevalence of depression among older hip fracture patients was 23%. Further research is needed to identify strategies for preventing and treating mood disorders in this population.
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Affiliation(s)
- Mohammad Eghbal Heidari
- Scientific Research Center, School of Nursing and Midwifery, Tehran University of Medical Sciences, School of Nursing Midwifery, Tehran University of Medical Sciences, Nosrat St, Tohid Sq, Tehran, Iran
| | - Seyed Sina Naghibi Irvani
- Shahid Beheshti University of Medical Sciences, Research Institute for Endocrine Science, Tehran, Iran.
| | - Pegah Dalvand
- Department of Mathematics, Shahrood University of Technology, Shahrood, Iran
| | - Mohaddeseh Khadem
- Scientific Research Center, School of Nursing and Midwifery, Tehran University of Medical Sciences, School of Nursing Midwifery, Tehran University of Medical Sciences, Nosrat St, Tohid Sq, Tehran, Iran
| | - Fereshte Eskandari
- Scientific Research Center, School of Nursing and Midwifery, Tehran University of Medical Sciences, School of Nursing Midwifery, Tehran University of Medical Sciences, Nosrat St, Tohid Sq, Tehran, Iran
| | - Fatemeh Torabi
- Scientific Research Center, School of Nursing and Midwifery, Tehran University of Medical Sciences, School of Nursing Midwifery, Tehran University of Medical Sciences, Nosrat St, Tohid Sq, Tehran, Iran
| | - Hooman Shahsavari
- Department of Medical-Surgical Nursing, School of Nursing and Midwifery, Tehran University of Medical Sciences, School of Nursing Midwifery, Tehran University of Medical Sciences, Nosrat St, Tohid Sq, Tehran, Iran
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Lin CE, Lee MS, Kao SY, Chung CH, Chen LF, Chou PH, Lee JF, Chien WC. Association between concurrent antidepressant and hypnotic treatment and the risk of dementia: A nationwide cohort study. J Affect Disord 2020; 277:549-558. [PMID: 32891061 DOI: 10.1016/j.jad.2020.08.025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 08/08/2020] [Accepted: 08/12/2020] [Indexed: 11/25/2022]
Abstract
OBJECTIVE This study aimed to investigate the risk of dementia among subgroups of patients receiving concurrent antidepressant and hypnotic treatment, antidepressants alone, and hypnotics alone. METHODS Multivariate Cox proportional hazards regression models were used to determine the effects of antidepressants and hypnotics on dementia risk after adjusting for potential confounders. RESULTS Compared with the reference group, patients receiving concurrent antidepressant and hypnotic treatment had the highest adjusted hazard ratio (aHR: 2.390, 95% CI: 2.224-2.536; P < 0.001) for all-cause dementia, followed by those receiving antidepressants alone (aHR: 1.919, 95% CI: 1.811-2.012; P < 0.001) and hypnotics alone (aHR: 1.458, 95% CI: 1.397-1.527; P < 0.001). With regard to dementia subtypes, trends similar to those for all-cause dementia were observed for Alzheimer's dementia, vascular dementia and other types of dementia. The sensitivity analysis conducted also found the robustness of findings. Notably, inconsistent findings were observed in subgroup with depression, revealing a null association between concurrent antidepressant and hypnotic treatment (aHR: 0.496; 95% CI: 0.183-1.343; P = 0.175) or hypnotics alone (aHR: 2.750; 95% CI: 0.797-9.482; P = 0.102) and the risk of dementia, and a negative association between antidepressants alone (aHR: 0.351; 95% CI: 0.130-0.942; P = 0.032) and the risk of dementia. CONCLUSION A null or negative association was observed between concurrent antidepressant and hypnotic treatment, antidepressants alone, hypnotics alone, and the dementia risk in the subgroup of patients with depression, suggesting the absence of an association between dementia risk and antidepressants alone or hypnotics alone.
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Affiliation(s)
- Ching-En Lin
- Department of Psychiatry, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taipei, Taiwan (ROC); School of Medicine, Tzu Chi University, Hualien, Taiwan (ROC); Graduate Institute of Life Science, National Defense Medical center, Taipei, Taiwan (ROC)
| | - Meei-Shyuan Lee
- School of Public Health, National Defense Medical Centre, Taipei, Taiwan (ROC); Graduate Institute of Life Science, National Defense Medical center, Taipei, Taiwan (ROC)
| | - Sen-Yeong Kao
- School of Public Health, National Defense Medical Centre, Taipei, Taiwan (ROC); Graduate Institute of Life Science, National Defense Medical center, Taipei, Taiwan (ROC)
| | - Chi-Hsiang Chung
- Department of Medical Research, Tri-Service General Hospital, Number 325, Section 2, Chenggong Road, Neihu District, Taipei 11490, Taiwan (ROC); School of Public Health, National Defense Medical Centre, Taipei, Taiwan (ROC)
| | - Li-Fen Chen
- School of Medicine, National Defense Medical Centre, Taipei, Taiwan (ROC); Department of Psychiatry, Hualien Armed Forces General Hospital, Hualien, Taiwan (ROC)
| | - Po-Han Chou
- Department of Psychiatry, China Medical University Hsinchu Hospital, China Medical University, Taichung, Taiwan (ROC); Department of Psychiatry, China Medical University Hospital, China Medical University, Taichung, Taiwan (ROC); Department of Biological Science and Technology, National Chiao Tung University, Hsinchu, Taiwan; Biological Optimal Imaging Lab, Department of Photonics, College of Electrical and Computer Engineering, National Chiao Tung University, Hsinchu, Taiwan (ROC)
| | - Jia-Fu Lee
- Department of Psychiatry, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taipei, Taiwan (ROC); School of Medicine, Tzu Chi University, Hualien, Taiwan (ROC)
| | - Wu-Chien Chien
- Department of Medical Research, Tri-Service General Hospital, Number 325, Section 2, Chenggong Road, Neihu District, Taipei 11490, Taiwan (ROC); School of Public Health, National Defense Medical Centre, Taipei, Taiwan (ROC); Graduate Institute of Life Science, National Defense Medical center, Taipei, Taiwan (ROC).
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Kumar M, Bajpai R, Shaik AR, Srivastava S, Vohora D. Alliance between selective serotonin reuptake inhibitors and fracture risk: an updated systematic review and meta-analysis. Eur J Clin Pharmacol 2020; 76:1373-1392. [PMID: 32556910 DOI: 10.1007/s00228-020-02893-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Accepted: 05/08/2020] [Indexed: 12/19/2022]
Abstract
PURPOSE In the past few years, several fracture-related events have been reported with chronic use of selective serotonin reuptake inhibitors (SSRIs) throughout the globe. Hence, an updated systematic review and meta-analysis was necessary to ascertain the risk involved. The present work evaluated the association of SSRIs with the risk of fracture in adults. METHODS We systematically searched PubMed, Cochrane library, and Google Scholar for observational studies on the same from inception to April 2019. Screening, data extraction, and risk of bias assessment were conducted independently by 2 authors. RESULTS We assessed 69 studies out of which 37 (14 case-control, 23 cohorts) were included. Our results showed that SSRIs were significantly associated with an increased fracture risk (relative risk of 1.62, 95% CI 1.52-1.73; P < 0.000; I2 = 90.8%). The relative risk values for case-control and cohort studies were found to be 1.80 (95% CI 1.58-2.03; P < 0.000; I2 = 93.2%) and 1.51 (95% CI 1.39-1.64; P < 0.000; I2 = 88.0%) respectively. Subgroup analysis showed that association of risk of fracture persisted regardless of geographical location, study design, risk factors, defined daily dose, SSRI use duration, site of the fracture, period of study and after adjusting for depression, physical activity, gender, and age group. The sensitivity analysis data shows that the studies adjusted for bone mineral density and osteoporosis show lesser fracture risk. CONCLUSION Our findings suggests that SSRIs may be associated with an increased fracture risk; hence, bone health should be taken into consideration while prescribing this class of drugs.
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Affiliation(s)
- Manoj Kumar
- Pharmaceutical Medicine, School of Pharmaceutical Education and Research, Jamia Hamdard, New Delhi, 110062, India
| | - Ram Bajpai
- Research Institute for Primary Care and Health Sciences, Keele University, Keele, Staffordshire, ST5 5BG, UK
| | - Abdul Rahaman Shaik
- Department of Pharmacology, School of Pharmaceutical Education and Research, Jamia Hamdard, New Delhi, 110062, India
| | - Swati Srivastava
- Central Drugs Standard Control Organization, Ministry of Health and Family Welfare, Directorate General of Health Services, Government of India, New Delhi, 110002, India
| | - Divya Vohora
- Pharmaceutical Medicine, School of Pharmaceutical Education and Research, Jamia Hamdard, New Delhi, 110062, India.
- Department of Pharmacology, School of Pharmaceutical Education and Research, Jamia Hamdard, New Delhi, 110062, India.
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Liu YC, Chen VCH, Lu ML, Lee MJ, McIntyre RS, Majeed A, Lee Y, Chen YL. The Association between Selective Serotonin Reuptake Inhibitors (SSRIs) Use and the Risk of Bladder Cancer: A Nationwide Population-Based Cohort Study. Cancers (Basel) 2020; 12:cancers12051184. [PMID: 32392848 PMCID: PMC7281365 DOI: 10.3390/cancers12051184] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Revised: 04/30/2020] [Accepted: 05/04/2020] [Indexed: 02/01/2023] Open
Abstract
Background: Past studies suggest mixed associations between selective serotonin reuptake inhibitor (SSRI) prescription and carcinogenic risk. There is no epidemiological study reporting on the association between SSRI use and the incidence of bladder cancer. The aim of this study is to determine whether SSRI use influences the risk of bladder cancer. Methods: We conducted a nationwide retrospective cohort study by Taiwan’s National Health Insurance Research Database from January 1, 1997 to December 31, 2013. 192,392 SSRI prescribed individuals were randomly matched 1 to 1 with 191,786 individuals who had never received any SSRIs by propensity scores match. The Cox Proportional Hazard models were conducted to examine the risk of bladder cancer between individuals prescribed SSRIs and individuals not prescribed SSRIs. Results: SSRIs were associated with significant reduced risk of bladder cancer with 0.5, 1, and 2 year induction periods (adjusted hazard ratio (aHR) = 0.86, 95% CI (confidence interval) = 0.76–0.98, aHR = 0.85, 95% CI = 0.75–0.97, and aHR = 0.77, 95% CI = 0.66–0.89). When examining the effect of specific SSRI, there was significantly lower risk of bladder cancer in individuals prescribed fluoxetine (6 month induction period: aHR = 0.78, 95% CI = 0.65–0.93; 1 year induction period: aHR = 0.78, 95% CI = 0.65–0.94; 2 year induction period: aHR = 0.73, 95% CI = 0.60–0.89), paroxetine (6 month induction period: aHR = 0.78, 95% CI = 0.61–0.99; 1 year induction period: aHR = 0.79, 95% CI = 0.61–1.01; 2 year induction period: aHR = 0.72, 95% CI = 0.54–0.95), and citalopram (6 month induction period: aHR = 0.74, 95% CI = 0.53–1.03; 1 year induction period: aHR = 0.70, 95% CI = 0.50–0.99; 2 year induction period: aHR = 0.60, 95% CI = 0.41–0.88). Conclusions: Individuals prescribed fluoxetine, paroxetine, or citalopram had a reduced risk of bladder cancer in this large, cross-national database.
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Affiliation(s)
- Yi-Chun Liu
- Taichung Hospital, Ministry of Health and Welfare, Taichung 40343, Taiwan;
| | - Vincent Chin-Hung Chen
- School of Medicine, Chang Gung University, Tauyuan 33302, Taiwan; (V.C.-H.C.); (M.-J.L.)
- Department of Psychiatry, Chiayi Chang Gung Memorial Hospital, Chiayi 61363, Taiwan
| | - Mong-Liang Lu
- Department of Psychiatry, Wan Fang Hospital and School of Medicine, College of Medicine, Taipei Medical University, Taipei 11696, Taiwan;
| | - Min-Jing Lee
- School of Medicine, Chang Gung University, Tauyuan 33302, Taiwan; (V.C.-H.C.); (M.-J.L.)
- Department of Psychiatry, Chiayi Chang Gung Memorial Hospital, Chiayi 61363, Taiwan
| | - Roger S. McIntyre
- Department of Psychiatry, University of Toronto, Toronto 399, ON M5T 2S8, Canada;
| | - Amna Majeed
- Mood Disorders Psychopharmacology Unit, University Health Network, Toronto 399, ON M5T 2S8, Canada; (A.M.); (Y.L.)
| | - Yena Lee
- Mood Disorders Psychopharmacology Unit, University Health Network, Toronto 399, ON M5T 2S8, Canada; (A.M.); (Y.L.)
| | - Yi-Lung Chen
- Department of Healthcare Administration, Asia University, Taichung 41354, Taiwan
- Department of Psychology, Asia University, Taichung 41354, Taiwan
- Correspondence: ; Tel.: +886-4-23323456 (ext. 20106); Fax: +886-4-23321206
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11
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Tamblyn R, Bates DW, Buckeridge DL, Dixon WG, Girard N, Haas JS, Habib B, Iqbal U, Li J, Sheppard T. Multinational Investigation of Fracture Risk with Antidepressant Use by Class, Drug, and Indication. J Am Geriatr Soc 2020; 68:1494-1503. [PMID: 32181493 PMCID: PMC7383967 DOI: 10.1111/jgs.16404] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Revised: 02/04/2020] [Accepted: 02/11/2020] [Indexed: 02/01/2023]
Abstract
OBJECTIVES Antidepressants increase the risk of falls and fracture in older adults. However, risk estimates vary considerably even in comparable populations, limiting the usefulness of current evidence for clinical decision making. Our aim was to apply a common protocol to cohorts of older antidepressant users in multiple jurisdictions to estimate fracture risk associated with different antidepressant classes, drugs, doses, and potential treatment indications. DESIGN Retrospective (2009–2014) cohort study. SETTING Five jurisdictions in the United States, Canada, United Kingdom, and Taiwan. PARTICIPANTS Older antidepressant users—subjects were followed from first antidepressant prescription or dispensation to first fracture or until the end of follow‐up. MEASUREMENTS The risk of fractures with antidepressants was estimated by multivariable Cox proportional hazards models using time‐varying measures of antidepressant dose and use vs nonuse, adjusting for patient characteristics. RESULTS Between 42.9% and 55.6% of study cohorts were 75 years and older, and 29.3% to 45.4% were men. Selective serotonin reuptake inhibitors (SSRIs) (48.4%‐60.0%) were the predominant class used in North America compared with tricyclic antidepressants (TCAs) in the United Kingdom and Taiwan (49.6%‐53.6%). Fracture rates varied from 37.67 to 107.18 per 1,000. The SSRIs citalopram (hazard ratio [HR] = 1.23; 95% confidence interval [CI] = 1.11‐1.36 to HR = 1.43; 95% CI = 1.11‐1.84) and sertraline (HR = 1.36; 95% CI = 1.10‐1.68), the SNRI duloxetine (HR = 1.41; 95% CI = 1.06‐1.88), TCAs doxepin (HR = 1.36; 95% CI = 1.00‐1.86) and imipramine (HR = 1.16; 95% CI = 1.05‐1.28), and atypicals (HR = 1.34; 95% CI = 1.14‐1.58) increased fracture risk in some but not all jurisdictions. In the United States and the United Kingdom, fracture risk with all classes was higher when prescribed for depression than chronic pain, a trend that is likely explained by drug choice. CONCLUSION The fracture risk for patients may be reduced by selecting paroxetine, an SSRI with lower risk than citalopram, the SNRI venlafaxine over duloxetine, and the TCA amitriptyline over imipramine or doxepin. There is uncertainty about the risk associated with the atypical antidepressants. J Am Geriatr Soc 68:1494‐1503, 2020.
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Affiliation(s)
- Robyn Tamblyn
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada.,Department of Medicine, McGill University Health Center, Montreal, Quebec, Canada.,Clinical and Health Informatics Research Group, McGill University, Montreal, Quebec, Canada
| | | | - David L Buckeridge
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada.,Clinical and Health Informatics Research Group, McGill University, Montreal, Quebec, Canada
| | - William G Dixon
- Centre for Epidemiology versus Arthritis, Centre for Musculoskeletal Research, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK
| | - Nadyne Girard
- Clinical and Health Informatics Research Group, McGill University, Montreal, Quebec, Canada
| | | | - Bettina Habib
- Clinical and Health Informatics Research Group, McGill University, Montreal, Quebec, Canada
| | - Usman Iqbal
- International Center for Health Information Technology (ICHIT), Taipei Medical University, Taipei, Taiwan.,Master's Program in Global Health and Development, PhD Program in Global Health and Health Security, College of Public Health, Taipei Medical University, Taipei, Taiwan
| | - Jack Li
- International Center for Health Information Technology (ICHIT), Taipei Medical University, Taipei, Taiwan.,Graduate Institute of Biomedical Informatics, College of Medicine Science and Technology, Taipei Medical University, Taipei, Taiwan.,Department of Dermatology, Taipei Wanfang Hospital, Taipei, Taiwan
| | - Therese Sheppard
- Centre for Epidemiology versus Arthritis, Centre for Musculoskeletal Research, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK
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12
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Kouvatsou K, Iliadou M, Kalatzi P, Evanthia S, Christos P, Maria K, Tziaferi S. Depression Among Elderly Users of Open and Closed Care Facilities in a Rural Region of Greece: an Important Public Health Issue. Mater Sociomed 2020; 32:35-40. [PMID: 32410889 PMCID: PMC7219719 DOI: 10.5455/msm.2020.32.35-40] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Introduction: It is estimated that 5.7% of the total Greek population suffers from depressive disorders. Elderly may be particularly prone to depression compared to younger people. In Greece, there is a paucity of literature regarding the correlation between the existence of chronic diseases, sociodemographic features, participation in open/ closed structures, and the presence of depression or depressive symptoms, among seniors. The purpose of this study was to explore potential correlations between the above- mentioned variables, as a whole. Methods: This was a cross- sectional, questionnaire survey of 200 elderly aged 65 or above and were members of 12 Open Care Centers for the Elderly (OCCE) or residents in 2 nursing homes located in the rural region of Epirus, in Greece. Data collection took place in the form of structured individual interviews. For the identification of independent factors associated with the existence of depressive symptoms, stepwise logistic regression analysis was performed. Results: A total of 81 (40.5%) seniors experienced depressive symptoms, though only 39 of them (19.5%) had been diagnosed for depression. Depression rates were higher for those with more chronic diseases (p=0.01) and at divorced, widowed and single seniors compared to married ones (50.5% vs. 28.1% respectively, p=0.002). The prevalence of depression was higher among the elderly who lived in nursing homes compared to the participants who were registered members of the OCCE (50% vs. 35.6% respectively, p=0.049), while elderly who often participated in the social activities of OCCE, had significantly lower rates of depressive symptoms compared to those who scarcely were involved in these activities (23% vs. 46.2% respectively, p=0.019). Participants who suffered from osteoporosis were more likely of displaying depressive symptoms compared to those who didn’t; OR (95% Confidence Interval) = 2.61 (1.28-5.33), p=0.009. Conclusions: The existence of an action plan that includes education and training of health professionals on mental health of the elderly and the satisfactory operation of public facilities to promote the wellbeing of seniors and offer more incentives for activity participation, may reduce depression rates and the under-diagnosis of the disease.
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Affiliation(s)
- Katerina Kouvatsou
- Department of Nursing, Faculty of Human Movement and Quality of Life Sciences, University of Peloponnese, Tripoli, Greece
| | - Maria Iliadou
- Department of Nursing, Faculty of Human Movement and Quality of Life Sciences, University of Peloponnese, Tripoli, Greece.,Department of Midwifery, Faculty of Health and Care Sciences, University of West Attica, Aigaleo, Athens, Greece
| | - Panagiota Kalatzi
- Department of Nursing, Faculty of Human Movement and Quality of Life Sciences, University of Peloponnese, Tripoli, Greece
| | - Sakellari Evanthia
- Department of Public and Community Health, Faculty of Public Health University of West Attica, Athens, Greece
| | - Prapas Christos
- Department of Public and Community Health, Faculty of Public Health University of West Attica, Athens, Greece
| | - Kalafati Maria
- Faculty of Nursing, National and Kapodistrian University of Athens, Athens, Greece
| | - Styliani Tziaferi
- Department of Nursing, Faculty of Human Movement and Quality of Life Sciences, University of Peloponnese, Tripoli, Greece
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13
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Kim SY, Lee JK, Oh DJ, Kong IG, Choi HG. Depression and incident hip fracture: A longitudinal follow-up study using a national sample cohort. Medicine (Baltimore) 2019; 98:e16268. [PMID: 31261597 PMCID: PMC6617478 DOI: 10.1097/md.0000000000016268] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
The aim of the present study was to evaluate the risk of hip fracture in depression patients using a nationwide cohort population.Data from the Korean National Health Insurance Service-National Sample Cohort for a population ≥50 years of age from 2002 to 2013 were collected. The 25,197 individuals with depression were matched for age, sex, income, region of residence, hypertension, diabetes, and dyslipidemia, with 100,788 individuals comprising the control group. In both the depression and control groups, history of hip fracture was evaluated. Using the International Classification of Disease-10 (ICD-10) codes, depression (F31-F39), and hip fracture (S720, S721, and S722) were investigated. The crude and adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) of hip fracture in depression patients were analyzed using a Cox proportional hazard model. Subgroup analyses were conducted according to age and sex.In the depression group, 1.1% (277/25,197) of the subjects had hip fracture, and 0.7% (693/100,095) in the control group had hip fracture (P <.001). The depression group demonstrated a higher adjusted HR for hip fracture than the control group (adjusted HR = 1.46, 95% CI = 1.27-1.68, P <.001). This result was consistent in the ≥65 years old subgroups.The risk of hip fracture was elevated in depression patients.
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Affiliation(s)
- So Young Kim
- Department of Otorhinolaryngology-Head & Neck Surgery, CHA Bundang Medical Center, CHA University, Seongnam
| | - Joon Kyu Lee
- Department of Orthopaedic Surgery, Hallym University Sacred Heart Hospital, Anyang
| | - Dong Jun Oh
- Department of Internal medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul
| | - Il Gyu Kong
- Department of Otorhinolaryngology-Head & Neck Surgery
| | - Hyo Geun Choi
- Department of Otorhinolaryngology-Head & Neck Surgery
- Hallym Data Science Laboratory, Hallym University College of Medicine, Anyang, Republic of Korea
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14
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Shi TT, Min M, Zhang Y, Sun CY, Liang MM, Sun YH. Depression and risk of hip fracture: a systematic review and meta-analysis of cohort studies. Osteoporos Int 2019; 30:1157-1165. [PMID: 30972449 DOI: 10.1007/s00198-019-04951-6] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Accepted: 03/21/2019] [Indexed: 12/13/2022]
Abstract
Recently published studies on the association between depression and hip fracture (HF) are inconsistent. Therefore, we performed this meta-analysis with the main aim to clarify the association between depression and HF, and also to identify possible susceptible groups. Relevant literature published until February 2019 was obtained and screened according to established inclusion criteria. Two researchers independently processed quality assessment and data extraction prior to the meta-analysis. Pooled hazard ratios (HRs) with 95%CI (confidence intervals) were calculated. To explore the sources of heterogeneity, subgroup analyses were performed based on study design, study region, NOS scores, follow-up duration, diagnostic criteria, sex, national income level, and adjustments (bone mineral density (BMD), antidepressant, calcium intake, and smoking). Ten studies with 13 estimates, involving 375,438 participants and 4576 HFs, were included. It was found that patients with depression had a higher risk of HF than non-depressed patients (HR = 1.21; 95%CI 1.11-1.31). Sensitivity analysis results show that the association is relatively stable. The studies that were not adjusted for confounders (e.g., antidepressant, BMD, calcium intake, and smoking) had higher overall HR compared to the studies that adjusted for the corresponding confounding factors. HFs are more likely to occur in European and male depression patients. This meta-analysis provided evidence of a modest positive association between depression and the risk of HFs, and the association is stronger in European and male patients. Implementation of practical measures to prevent and treat depression is of great public health significance.
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Affiliation(s)
- T T Shi
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, No. 81 Meishan Road, Hefei, 230032, Anhui, China
| | - M Min
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, No. 81 Meishan Road, Hefei, 230032, Anhui, China
| | - Y Zhang
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, No. 81 Meishan Road, Hefei, 230032, Anhui, China
| | - C Y Sun
- AMITA Health Saint Joseph Hospital Chicago, Chicago, 60657, Illinois, USA
| | - M M Liang
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, No. 81 Meishan Road, Hefei, 230032, Anhui, China
| | - Y H Sun
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, No. 81 Meishan Road, Hefei, 230032, Anhui, China.
- Center for Evidence-Based Practice, Anhui Medical University, No. 81 Meishan Road, Hefei, 230032, Anhui, China.
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15
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Brännström J, Lövheim H, Gustafson Y, Nordström P. Association Between Antidepressant Drug Use and Hip Fracture in Older People Before and After Treatment Initiation. JAMA Psychiatry 2019; 76:172-179. [PMID: 30601883 PMCID: PMC6440395 DOI: 10.1001/jamapsychiatry.2018.3679] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
IMPORTANCE Treatment with antidepressants has been associated with hip fracture. This association could restrict the treatment options, especially in older patients. OBJECTIVE To investigate the association between antidepressant drug treatment and hip fracture starting 1 year before the initiation of treatment. DESIGN, SETTING, AND PARTICIPANTS In this nationwide cohort study, 204 072 individuals in the Prescribed Drugs Register of Sweden's National Board of Health and Welfare aged 65 years or older who had a prescription of antidepressants filled between July 1, 2006, and December 31, 2011, were matched by birth year and sex to 1 control participant who was not prescribed antidepressants (for a total of 408 144 people in the register). Outcome data were collected from 1 year before to 1 year after the index date (date of prescription being filled). Data analysis was performed from July 1, 2005, to December 31, 2012. EXPOSURES First filled prescription of an antidepressant drug. MAIN OUTCOMES AND MEASURES Incident hip fractures occurring in the year before and year after initiation of antidepressant therapy were registered. Associations were investigated using multivariable conditional logistic regression models and flexible parametric models. RESULTS Of the 408 144 people in the register who were included in the study, 257 486 (63.1%) were women, with a mean (SD) age of 80.1 (7.2) years. Antidepressant users sustained more than twice as many hip fractures than did nonusers in the year before and year after the initiation of therapy (2.8% vs 1.1% and 3.5% vs 1.3%, respectively, per actual incidence figures). In adjusted analyses, the odds ratios were highest for the associations between antidepressant use and hip fracture 16 to 30 days before the prescription was filled (odds ratio, 5.76; 95% CI, 4.73-7.01). In all separate analyses of age groups, of men and women, and of individual antidepressants, the highest odds ratios were seen 16 to 30 days before initiation of treatment, and no clear dose-response relationship was seen. CONCLUSIONS AND RELEVANCE The present study found an association between antidepressant drug use and hip fracture before and after the initiation of therapy. This finding raises questions about the association that should be further investigated in treatment studies.
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Affiliation(s)
- Jon Brännström
- Department of Community Medicine and Rehabilitation, Geriatric Medicine, Umeå University, Umeå, Sweden
| | - Hugo Lövheim
- Department of Community Medicine and Rehabilitation, Geriatric Medicine, Umeå University, Umeå, Sweden
| | - Yngve Gustafson
- Department of Community Medicine and Rehabilitation, Geriatric Medicine, Umeå University, Umeå, Sweden
| | - Peter Nordström
- Department of Community Medicine and Rehabilitation, Geriatric Medicine, Umeå University, Umeå, Sweden
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16
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Khanassov V, Hu J, Reeves D, van Marwijk H. Selective serotonin reuptake inhibitor and selective serotonin and norepinephrine reuptake inhibitor use and risk of fractures in adults: A systematic review and meta-analysis. Int J Geriatr Psychiatry 2018; 33:1688-1708. [PMID: 30247774 DOI: 10.1002/gps.4974] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2017] [Accepted: 08/06/2018] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To evaluate the association between selective serotonin reuptake inhibitor (SSRI) and selective serotonin and norepinephrine reuptake inhibitor (SNRI) use and risk of fractures in older adults. METHODS We systematically identified and analyzed observational studies comparing SSRI/SNRI use for depression with non-SSRI/SNRI use with a primary outcome of risk of fractures in older adults. We searched for studies in MEDLINE, PsycINFO, Embase, DARE (Database of Abstracts or Reviews of Effects), the Cochrane Library, and Web of Science clinical trial research registers from 2011 for SSRIs and 1990 for SNRIs to November 29, 2016. RESULTS Thirty-three studies met our inclusion criteria; 23 studies were included in meta-analysis: 9 case-control studies and 14 cohort studies. A 1.67-fold increase in the risk of fracture for SSRI users compared with nonusers was observed (relative risk 1.67, 95% CI 1.56-1.79, P = .000). The risk of fracture increases with their long-term use: within 1 year, the risk is 2.9% or 1 additional fracture in every 85 users; within 5 years, the risk is 13.4% or 1 additional fracture in every 19 users. In meta-regression, we found that the increase in risk did not differ across age groups (odds ratio = 1.006; P = .173). A limited number of studies on SNRI use and the risk of fractures prevented us from conducting a meta-analysis. CONCLUSIONS Our systematic review showed an association between risk of fracture and the use of SSRIs, especially with increasing use. Age does not increase this risk. No such conclusions can be drawn about the effect of SNRIs on the risk of fracture because of a lack of studies.
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Affiliation(s)
| | - Jingyi Hu
- University of Manchester, Manchester, UK
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17
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Association between depression and the risk for fracture: a meta-analysis and systematic review. BMC Psychiatry 2018; 18:336. [PMID: 30333001 PMCID: PMC6192066 DOI: 10.1186/s12888-018-1909-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2018] [Accepted: 09/25/2018] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Several studies have suggested that depression is associated with an increased risk for fracture; however, the results are conflicting. This study aimed to conduct a meta-analysis of cohort studies assessing the association between depression and the risk for fracture. METHODS Relevant studies were identified by a search of Web of Science, PubMed, Embase, China National Knowledge Infrastructure and WanFang database to Feb 2018. Cohort studies on the relationship between depression and the risk for fracture in the general population were included in the meta-analysis. Data collection was in accordance with the Meta-analysis of Observational Studies in Epidemiology (MOOSE) guidelines, and the quality of the included studies was assessed using the Newcastle-Ottawa scale. Two independent investigators screened the abstracts and full texts of the studies, extracted data, and assessed the quality of the study. Either a fixed-effect or random-effects model was used to compute the pooled risk estimates when appropriate. RESULTS In total, 16 cohort studies with 25 independent reports that included 414,686 participants during a follow-up duration of 3-14 years were included in the analysis. The pooled hazard ratio (HR) for total fracture was 1.24 (95% confidence interval [CI]: 1.14-1.35; P < 0.001 for heterogeneity; random-effects model). In the subgroup analyses conducted in terms of study region, the pooled HR for the studies conducted in Europe was higher (HR: 1.76; 95% CI: 1.44-2.17; P = 0.792 for heterogeneity) than that in America and Asia, with a significant difference between the groups (P = 0.036). CONCLUSION The results of our meta-analysis suggest that depression is prospectively associated with a significantly increased risk for fracture, which may have substantial implications, both clinical and preventive.
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18
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Abstract
UNLABELLED This meta-analysis pooled results from 23 qualifying individual cohort studies and found that depression was significantly associated with an increased risk of fractures and bone loss. INTRODUCTION The association between depression and risk of fracture remains controversial. We conducted a comprehensive meta-analysis to examine the effect of depression on the risk of osteoporotic fractures and bone loss. METHODS We searched databases and reviewed citations in relevant articles for eligible cohort studies. Two investigators independently conducted study selection, appraisal, and data abstraction through the use of a standardized protocol. Random effect models were used for meta-analysis. Cochrane Q and I2 statistics were used to assess heterogeneity. Funnel plots and rank correlation tests were used to evaluate publication bias. RESULTS Twenty-three studies were included for meta-analysis. In studies that reported hazard ratio (HR) as the outcome (nine studies [n = 309,862]), depression was associated with 26% increase in fracture risk (HR = 1.26, 95% CI, 1.10-1.43, p < 0.001). Studies that reported risk ratio (RR) as the outcome (seven studies [n = 64,975]) suggested that depression was associated with 39% increase in fracture risk (RR = 1.39, 95% CI, 1.19-1.62, p < 0.001). Among studies that reported hip bone mineral density (BMD) as an outcome (eight studies [n = 15,442]), depression was associated with a reduced mean annual bone loss rate of 0.35% (0.18-0.53%, p < 0.001). The increased risk of fracture and bone loss associated with depression was consistent in all meta-analysis having modified inclusion criteria and in different subgroup analyses as well. Significant heterogeneity was observed in the meta-analysis; however, no significant publication bias was detected. CONCLUSION Depression is associated with a significant increased risk in fracture and bone loss. Effective prevention may decrease such risk.
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Affiliation(s)
- Q Wu
- Nevada Institute of Personalized Medicine, Department of Environmental & Occupational Health School of Community Health Sciences, University of Nevada, Las Vegas, NV, 89154, USA.
| | - B Liu
- Nevada Institute of Personalized Medicine, Department of Environmental & Occupational Health School of Community Health Sciences, University of Nevada, Las Vegas, NV, 89154, USA
- Department of Mathematical Science, University of Nevada, Las Vegas, NV, USA
| | - S Tonmoy
- Department of Mathematical Science, University of Nevada, Las Vegas, NV, USA
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Lo C, Sung FC, Mou CH, Lin TC, Tseng CH, Tzeng YL. Population study evaluating fracture risk among patients with chronic osteomyelitis. PLoS One 2017; 12:e0189743. [PMID: 29267371 PMCID: PMC5739410 DOI: 10.1371/journal.pone.0189743] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Accepted: 11/30/2017] [Indexed: 11/18/2022] Open
Abstract
Background Studies investigating the fracture risk in patients with chronic osteomyelitis (COM) limited to case reports. This study evaluated the association between COM and subsequent fracture risk using population-based data. Methods A subset claims data of the Taiwan National Health Insurance was used to identify 7,147 patients with COM newly diagnosed in 1999–2005 without fracture history and 28,588 general population controls, frequency matched by sex, age and diagnosis date. The incident fractures was measured by the end of 2013. Results The incidence density of fracture was 1.94-fold greater in the COM cohort than in controls (21.5 vs. 11.1 per 1000 person-years), with the adjusted hazard ratio (HR) of 1.81 (95% CI: 1.67–1.95) for COM patients compared to controls after controlling for sex, age, and comorbidities of diabetes, osteoporosis, depression and end-stage renal disease in Cox proportional hazards regression. The fracture risk increased with age and women were at greater risk than men. The fracture incidence increased substantially in those with osteoporosis, 40.2 per 1000 person-years in COM patients. Site specific analysis showed a higher portion of incident fractures for lower limbs, 52.7% in COM cohort and 46.3% in controls. Conclusion Findings in this 15-year follow-up observation support our hypothesis that patients with COM are at an elevated risk of subsequent fracture. COM patients and the elderly deserve adequate consultation and awareness for fracture prevention.
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Affiliation(s)
- Chyi Lo
- School of Nursing, College of Health Care, China Medical University, Taichung, Taiwan
- Department of Nursing, China Medical University Hospital, Taichung, Taiwan
| | - Fung-Chang Sung
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan
- Department of Health Services Administration, China Medical University, Taichung, Taiwan
| | - Chih-Hsin Mou
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan
| | - Tzu-Chieh Lin
- Division of Traumatology, Emergency Department, Taichung Veterans General Hospital, Taichung, Taiwan
- Department of Public Health, China Medical University, Taichung, Taiwan
| | - Chun-Huang Tseng
- Department of Neurology, China Medical University Hospital, Taichung, Taiwan
| | - Ya-Ling Tzeng
- School of Nursing, College of Health Care, China Medical University, Taichung, Taiwan
- Department of Nursing, China Medical University Hospital, Taichung, Taiwan
- * E-mail:
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Hung YC, Lin CC, Chen HJ, Chang MP, Huang KC, Chen YH, Chen CC. Severe hypoglycemia and hip fracture in patients with type 2 diabetes: a nationwide population-based cohort study. Osteoporos Int 2017; 28:2053-2060. [PMID: 28374044 DOI: 10.1007/s00198-017-4021-4] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2016] [Accepted: 03/27/2017] [Indexed: 02/01/2023]
Abstract
UNLABELLED Hypoglycemia is a major concern in glycemic control. Using the Taiwan National Health Insurance Research Database, we found that the risk of hip fracture was associated with emergency or hospitalization visits of severe hypoglycemia in patients with type 2 diabetes; greater visits were associated with higher incidence of hip fracture. INTRODUCTION The objective of the study was to assess the risk of hip fracture among patients with type 2 diabetes mellitus (T2DM) and severe hypoglycemia. METHODS Using the National Health Insurance Research database in Taiwan, we identified 2588 patients with T2DM who had developed severe hypoglycemia from 2001 to 2009. A comparison cohort who had never developed severe hypoglycemia was frequency matched at a ratio of approximately 1:2. Multivariate Cox proportional hazard regression analysis was used to evaluate the risk of hip fracture. RESULTS During a median follow-up period of 3.9 years, there were 219 hip fracture events in 5173 comparison cohorts and 148 hip fracture events in 2588 hypoglycemia cohorts. The incidence of hip fracture was higher in patients with severe hypoglycemia than without severe hypoglycemia (17.19 vs. 8.83 per 1000 person-years; adjusted HR 1.71, 95% CI = 1.35-2.16). Approximately half of the individuals developed hip fracture within 2 years from the first occurrence of severe hypoglycemia. There was a significant associated trend towards increased hip fracture risk with increasing average visit of severe hypoglycemia per year (p for trend <0.001). Medication analysis showed that patients taking sulfonylurea alone, insulin alone, and insulin secretagogues combined with insulin had a higher associated risk to develop hip fracture. CONCLUSIONS Severe hypoglycemia was associated with a higher risk to develop hip fracture. The more the visits of severe hypoglycemia per year indicated the higher associated risk in patients with T2DM. Fall is likely an important reason for severe hypoglycemia in relation to increased risk of hip fracture.
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Affiliation(s)
- Y C Hung
- Division of Endocrinology and Metabolism, Department of Medicine, China Medical University Hospital, 2, Yuh-Der Road, Taichung, 40447, Taiwan
- Department of Medicine, China Medical University, Taichung, 40402, Taiwan
| | - C C Lin
- Management Office for Health Data, China Medical University Hospital, Taichung, 40447, Taiwan
- Veterans General Hospital, Taichung, Taiwan
| | - H J Chen
- Management Office for Health Data, China Medical University Hospital, Taichung, 40447, Taiwan
| | - M P Chang
- Department of Nursing, School of Health, National Taichung University of Science and Technology, Taichung, 40343, Taiwan
| | - K C Huang
- Department of Integration of Traditional Chinese and Western Medicine, China Medical University Hospital, Taichung, 40447, Taiwan
- School of Chinese Medicine, China Medical University, Taichung, 40402, Taiwan
| | - Y H Chen
- Division of Endocrinology and Metabolism, Department of Medicine, China Medical University Hospital, 2, Yuh-Der Road, Taichung, 40447, Taiwan
- Department of Medicine, China Medical University, Taichung, 40402, Taiwan
| | - C C Chen
- Division of Endocrinology and Metabolism, Department of Medicine, China Medical University Hospital, 2, Yuh-Der Road, Taichung, 40447, Taiwan.
- School of Chinese Medicine, China Medical University, Taichung, 40402, Taiwan.
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Risk analysis of use of different classes of antidepressants on subsequent dementia: A nationwide cohort study in Taiwan. PLoS One 2017; 12:e0175187. [PMID: 28384235 PMCID: PMC5383251 DOI: 10.1371/journal.pone.0175187] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Accepted: 03/22/2017] [Indexed: 01/27/2023] Open
Abstract
Depression and dementia are common mental health problems and are associated in several ways. Early-life depression is associated with increased risk of later life dementia, and depression can present as a preclinical symptom or consequence of dementia. Despite the plausible relationship between these two clinical entities, the potential association between antidepressant medication and dementia has rarely been investigated. We conducted a 9-year retrospective analysis of Taiwan’s National Health Insurance Research Database (NHIRD), enrolling 5819 cases who had received prescriptions of antidepressants between 2003 and 2006, and 23,276 (with ratio of 1:4) age, sex, and index date-matched controls. The hazard ratio (HR) of dementia among antidepressant users with depression was 2.42 (95% confidence interval (CI): 1.15–5.10), for those without depression was 4.05 (95% CI: 3.19–5.15), compared to antidepressant non-users respectively. Among the 6 classes of common antidepressants used in Taiwan, the adjusted HRs were 3.66 (95% CI: 2.62–5.09) for SSRIs, 4.73 (95% CI: 2.54–8.80) for SNRI, 3.26 (95% CI: 2.30–4.63) for TCAs, 6.62 (95% CI: 3.34–13.13) for TeCA, 4.94 (95% CI: 2.17–11.24) for MAOI, and 4.48 (95% CI: 3.13–6.40) for SARI. Furthermore, the multivariate analysis result showed that the adjusted HRs of cumulative defined daily doses (cDDDs) were 3.74 (95% CI: 2.91–4.82), 3.73 (95% CI: 2.39–5.80) and 5.22 (95% CI: 3.35–8.14) for those who had cDDDs of <90, 90–180 and >180 compared to those who had taken no antidepressant medication. This is a retrospective study based on secondary data, hence, we could not claim causality between antidepressant medication and dementia. However, a potential association between antidepressant and occurrence of dementia after controlling for the status of depression was observed. Lack of patients’ data about smoking status and body mass index in NHIRD, which are considered related to dementia, was also a limitation in this study. In this study, we concluded that antidepressant medication is a potential risk factor for dementia, independent from any effect of depression itself.
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