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Anxiety levels predict fracture risk in postmenopausal women assessed for osteoporosis

Catalano, Antonino, MD, PhD1; Martino, Gabriella, MD, PhD2; Bellone, Federica, MD1; Gaudio, Agostino, MD, PhD3; Lasco, Carmen, MS1; Langher, Viviana, MD4; Lasco, Antonino, MD1; Morabito, Nunziata, MD1

doi: 10.1097/GME.0000000000001123
Original Articles

Objective: There has been increasing interest in the association of psychiatric disorders with fracture risk. This study aimed at investigating the role of severity of anxiety in bone health.

Methods: Multiple clinical risk factors for fractures, the Fracture Risk Assessment Tool score, the bone mineral density (BMD) at the lumbar spine and femoral neck, Hamilton Anxiety Rating Scale (HAMA) scores, Beck Depression Inventory scores, and the 36-Item Short Form Health Survey (SF-36) scores for evaluation of the quality of life were determined, and x-ray vertebral morphometry was carried out in postmenopausal women referred for osteoporosis.

Results: Of the 192 women recruited (mean age 67.5 ± 9.5 years), participants allocated to the tertile of the lowest HAMA scores (HAMA-1) showed a lower probability of fracture than did participants with the highest scores (HAMA-3) (20.44 ± 9.3 vs 24.94 ± 13%, respectively; P = 0.01), and the same trend was observed when comparing the HAMA-2 and HAMA-3 tertiles. Women in the HAMA-3 group exhibited lower lumbar T-score vales in the lumbar spine than did women in the HAMA-1 group (−2.84 ± 1.4 vs −2.06 ± 1.2 SD, respectively; P < 0.001) and a lower T-score value in the femoral neck (−2.21 ± 0.9 vs −1.93 ± 0.6 SD, respectively; P < 0.05). Lower T-score values were observed in HAMA-3 than in HAMA-2. A higher prevalence rate of vertebral fractures was observed in HAMA-3 than in HAMA-1, but the difference was not significant. Anxiety levels were significantly related to age, menopausal age, years since menopause, and depressive symptoms, and a multiple regression analysis was predictive of reduced BMD in the lumbar spine (β = −0.00672, SE = 0.001, P = 0.0002).

Conclusion: In postmenopausal women, anxiety levels were associated with BMD in the lumbar spine and femoral neck.

1Department of Clinical and Experimental Medicine, University Hospital of Messina, Messina, Italy

2Department of Cognitive Sciences, Psychology, Education and Cultural Studies, University of Messina, Messina, Italy

3Department of Clinical and Experimental Medicine, University Hospital of Catania, Catania, Italy

4Department of Dynamic and Clinical Psychology, University of Rome “Sapienza”, Rome, Italy.

Address correspondence to: Antonino Catalano, MD, PhD, Department of Clinical and Experimental Medicine; University Hospital of Messina; Via C. Valeria, 98125 Messina, Italy. E-mail:

Received 9 January, 2018

Revised 26 March, 2018

Accepted 26 March, 2018

AC and GM have equally contributed to the study. AL and NM are senior authors.

Funding/support: This research did not receive any specific grant from any funding agency in the public, commercial, or not-for-profit sector.

Financial disclosure/conflicts of interest: None reported.

© 2018 by The North American Menopause Society.