Psychological Disorders Linked to Osteoporosis Diagnoses in a Population-Based Cohort Study of Middle and Older Age United States Adults

Abstract

Background and Objectives Although it is well-established that psychological disorders and osteoporosis risk are linked, how the relationship manifests is not. This study examines depressive symptoms and a history of psychological problems as potential risk factors for osteoporosis diagnosis, adjudicating between four theoretical models rarely tested together. We analyze these models across multiple domains (i.e., demographic, socioeconomic, and health-related), while accounting for bone mineral density (BMD) scans, which have been shown to improve health equity across sex and racial/ethnic identities. Research Design and Methods Data from the 2012-2016, nationally representative, population-based, cohort Health and Retirement Study (N=18,224 to 18,359) were used to estimate four logistic regression models with the outcome of osteoporosis diagnosis. Approximately 50% of the sample identified as female and 50% as male, while about 81% identified as White/European American, 11% as Black/African American, and 8% as another race/ethnicity. The key independent variables were depressive symptoms—measured using two common scales —and a history of psychological problems. Results A history of psychological problems and one depressive symptoms measure were associated with the odds of osteoporosis diagnosis in the presence of other known risk factors for osteoporosis. Discussion and Implications Support for the theoretical models was limited. Evidence suggests possible directionality; a history of psychological distress may be a risk factor for osteoporosis, though we cannot rule out the other direction. Public health professionals and health care providers should consider a history of psychological problems as a risk factor for osteoporosis when deciding whether to recommend a BMD scan.