Association of depressive symptoms with bone mineral density in older men: A population-based study Alice Laudisio 1 * , Emanuele Marzetti 2 , Alberto Cocchi 1 , Roberto Bernabei 1 and Giuseppe Zuccala ` 1 1 Department of Gerontology and Geriatrics, Catholic University of Medicine, L.go F. Vito1, Rome, Italy 2 Department of Aging and Geriatrics, College of Medicine, University of Florida, Division of Biology of Aging, Institute on Aging, Biochemistry of Aging Laboratory, Gainesville, FL, USA SUMMARY Objective Thirty percent of hip fractures occur in men; nevertheless, the determinants of osteoporosis in men are unclear. Methods We assessed the association of ultrasound-derived bone mineral density (UD-BMD) with depressive symptoms in a population-based study. We assessed the association of 30-item Geriatric Depression Scale (GDS) score with the ultrasound-derived T-score, Z-score, and Stiffness index in all 306 subjects aged 75 þ living in Tuscania (Italy). Results In multivariable linear regression analysis, GDS was associated among men with the ultrasound-derived T -score (b ¼0.09; 95% CI ¼0.15 to 0.03; p ¼ 0.003), Z-score (b ¼0.07; 95% CI ¼0.13 to 0.01; p ¼ 0.032), and the Stiffness index (b ¼0.90; 95% CI ¼1.64 to 0.16; p ¼ 0.018) after adjusting for potential confounders. No significant associations were observed in women. In linear discriminant analysis, the GDS score cutoff that best predicted osteoporosis was 19. Participants with mild to severe depressive symptoms had threefold increased probability of having an ultrasound-derived T -score < 2.5. Conclusions Depressive symptoms are independently associated with all UD-BMD parameters. As depression is a common feature among older populations, and because subjects with depression are infrequent users of preventive services, older men with depression should be prompted to undergo screening for osteoporosis. Conversely, assessment for depression should be performed in older men with diagnosis of osteoporosis. Copyright # 2008 John Wiley & Sons, Ltd. key words — osteoporosis; depressive symptoms; elderly; epidemiology INTRODUCTION The prevalence and incidence rates of osteoporotic fractures are constantly increasing in Western countries, paralleling the aging of populations; a twofold increase in incident hip fractures worldwide is expected within 2050 (Sambrook and Cooper, 2006). Direct medical costs of treating such fractures are estimated to average $ 3.8 billion, and are further arising (Ray et al., 1997). Also, the human costs associated with these fractures (such as increased mortality, functional decline, disability, institutionali- zation) should be added (Lyles et al., 1993; Schu ¨rch et al., 1996; Fox et al., 1998). Thirty percent of hip fractures occur in men, whose mortality rates are significantly higher than in women (Cooper et al., 1992); of notice, survival of older men is significantly reduced following any type of fracture (Center et al., 1999). Despite such an evidence, knowledge of the determinants of osteoporosis in men in still poor (Amin et al., 2006). This lack of information about the aetiologic factors of osteoporosis in older men hinders the development of effective preventive programs in elderly male populations. Depression is a prevalent public health problem. The prevalence rates of depressive symptoms in elderly populations are even higher, ranging 12–28% according to the settings (Penninx et al., 1998; Peytremann-Bridevaux et al., 2008). Some studies have evidenced an association of depression with falls and fractures in older populations INTERNATIONAL JOURNAL OF GERIATRIC PSYCHIATRY Int J Geriatr Psychiatry 2008; 23: 1119–1126. Published online 6 May 2008 in Wiley InterScience (www.interscience.wiley.com) DOI: 10.1002/gps.2037 *Correspondence to: Dr A. Laudisio, Department of Gerontology and Geriatrics, Catholic University of Medicine, L.go F. Vito, 1–00168 Rome, Italy. E-mail: postalice@tiscali.it Copyright # 2008 John Wiley & Sons, Ltd. Received 11 October 2007 Accepted 17 March 2008