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Cited by 31Bone health and osteoporosis researchHip and Femur FracturesTreatment of Major Depression

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Effects of depression and antidepressant medications on hip fracture: A population-based cohort study in Taiwan

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Cheng, Bi-Hua, Chen, Pau-Chung, Yang, Yao-Hsu, Lee, Chuan-Pin, Huang, Ko-En, Chen, Vincent C.·2016·Medicine
DOI 10.1097/md.0000000000004655PMC PMC5023880
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Abstract

This study was conducted to investigate the effects of depression and antidepressant medications on hip fracture. The database of the Taiwan National Health Insurance with medical records of more than 1,000,000 individuals was searched for patients who had hip fracture with or without depression from 1998 to 2009. Patients with the following conditions were excluded: hip fracture due to cancer or traffic accidents, hip fracture that occurred before the diagnosis of depression, and use of antidepressants before the diagnosis of depression. A matched cohort of 139,110 patients was investigated, including 27,822 (17,309 females; 10,513 males) with depression and 111,288 (69,236 females; 42,052 males) without depression (1:4 randomly matched with age, sex, and index date). Among these patients, 232 (158 females and 74 males) had both hip fracture and depression, and 690 (473 females and 217 males) had hip fracture only. The Cox proportional-hazards regression method was used to determine the effect of depression on hip fracture. The hazard ratio (HR) for each clinical parameter was calculated after adjusting for confounders including sex, age, Charlson comorbidity index, urbanization, osteoporosis, and antidepressants. Results showed that patients with major depressive disorder had a 61% higher incidence of hip fracture than those without depression (HR 1.61, 95% confidence interval [CI] 1.19-2.18, P = 0.002). The risk of hip fracture for patients with less severe depressive disorder (dysthymia or depressive disorder, not otherwise specified) was not statistically higher than that of patients with no depression (HR 1.10, 95% CI = 0.91-1.34, P = 0.327). Among the patients with depression, females had a 49% higher incidence for hip fracture than males (HR 1.49, 95% CI 1.30-1.72, P < 0.001). The incidence of hip fracture also increased with age and Charlson comorbidity index scores. Analyses of both all (139,110) patients and only patients (27,822) with depression revealed that antidepressants had no negative impact on the incidence of hip fracture. In conclusion, major depression was found to be a risk factor for hip fracture and that use of antidepressants had no adverse effect on hip fracture in the Taiwanese population.

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  • The 30-day criterion for antidepressant users is widely accepted in other studies.

    “and this criterion is widely accepted in other studies [40-42].”

    From Risk analysis of use of different classes of antidepressants on subsequent dementia: A nationwide cohort study in Taiwan (2017) · cites this paper as [41]

    The Drug evaluation section (page unavailable) defines antidepressant exposure using defined daily doses and includes only patients treated for more than 180 days. The Discussion (page unavailable) mentions a 1–30-day window for dopaminergic drugs in another study, but does not say that a 30-day criterion for antidepressant users is widely accepted. Searches for that criterion and its use in other studies found no supporting passage. (LLM, conf=0.76)

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Metadata

Authors
Cheng, B.-H., Chen, P.-C., Yang, Y.-H., Lee, C.-P., Huang, K.-E., & Chen, V. C.
Affiliations
  • National Taiwan University (TW)
  • Chang Gung Memorial Hospital (TW)
  • Chang Gung University (TW)
Corresponding author
  • Huang, Ko-En
  • Chen, Vincent C.
ORCID
Venue
Medicine
Publisher
Ovid Technologies (Wolters Kluwer Health)
Published
2016-09
Volume
95
Issue
36
Pages
e4655
ISSN
0025-7974 (ISSN-L)
DOI
10.1097/md.0000000000004655
PMC
PMC5023880
OpenAlex
W2512423195
Cited by
31
References
13
Citations by year
2026: 1 · 2025: 3 · 2024: 2 · 2022: 4 · 2021: 3 · 2020: 8 · 2019: 4 · 2018: 3 · 2017: 3
FWCI
3.59
Type
journal article
Language
en
Open access
Licence
cc-by-nc-nd
Locations
  • Medicine (publishedVersion, cc-by-nc-nd)
  • PubMed Central (publishedVersion, cc-by-nc-nd)
  • PubMed (publishedVersion)
Funders
Chang Gung Medical Foundation
Topics
  • Health Sciences › Medicine › Orthopedics and Sports Medicine › Bone health and osteoporosis research
  • Health Sciences › Medicine › Surgery › Hip and Femur Fractures
  • Health Sciences › Medicine › Pharmacology (medical) › Treatment of Major Depression
Keywords
depression, major depressive disorder, antidepressants, dysthymia, sex differences, Charlson Comorbidity Index, osteoporosis, fracture risk, Taiwan National Health Insurance Research Database, matched cohort analysis, sex differences in fracture risk
MeSH terms
Adolescent, Adult, Aged, Aged, 80 and over, Antidepressive Agents, Child, Child, Preschool, Depression, Depressive Disorder, Female, Hip Fractures, Humans, Infant, Male, Middle Aged, Taiwan, Cohort Studies, Incidence, Young Adult

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