{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,25]],"date-time":"2026-06-25T04:51:36Z","timestamp":1782363096694,"version":"3.54.5"},"reference-count":26,"publisher":"BMJ","issue":"6","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Epidemiol Community Health"],"published-print":{"date-parts":[[1999,6]]},"abstract":"<jats:p>OBJECTIVE: Mental distress may entail increased risk of hip fracture, but it is uncertain whether the effect consists solely of an indirect effect through use of medication, or whether it is also mediated through other mechanism. The purpose of this study was to examine the association between mental distress and risk of hip fracture in women, adjusted for medication (that is, use of tranquillisers\/sedatives or hypnotics). DESIGN: A three year follow up of hip fracture was conducted on 18,612 women, consisting of 92.5% of all women aged 50 years or older in a Norwegian county. Three hundred and twenty nine suffered a hip fracture. A mental distress index was based on questions about life dissatisfaction, nervousness, loneliness, sleep disorders, troubled and uneasy feelings, depression and impairment attributable to psychological complaints. Relative risk with 95% confidence intervals (CI) of hip fracture with respect to mental distress were controlled for medication, age, body mass index (BMI), smoking, physical inactivity, and physical illness by means of Cox regression. RESULTS: The 10% of women with the highest mental distress had more than twofold increased risk of hip fracture compared with the 10% of women with the lowest mental distress, after adjustment for age and medication. The relative risk was 1.95 (95% CI 1.2, 3.3) after additional control for BMI, smoking, physical inactivity, and physical illness. The relative risk of hip fracture for daily users of medication compared with never users was 2.1 (95% CI 1.6, 2.9). After adjusting for mental distress it was 1.5 (95% CI 1.0, 2.2). CONCLUSIONS: Risk of hip fracture was positively related to mental distress, also after adjustment for medication use. The effect of tranquillisers\/sedatives or hypnotics on hip fracture risk may be overestimated in studies with no adjustments for mental distress.<\/jats:p>","DOI":"10.1136\/jech.53.6.343","type":"journal-article","created":{"date-parts":[[2009,1,5]],"date-time":"2009-01-05T14:15:53Z","timestamp":1231164953000},"page":"343-347","source":"Crossref","is-referenced-by-count":53,"title":["Mental distress and risk of hip fracture. Do broken hearts lead to broken bones?"],"prefix":"10.1136","volume":"53","author":[{"given":"L","family":"Fors\u00e9n","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"H E","family":"Meyer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A J","family":"S\u00f8gaard","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S","family":"Naess","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"B","family":"Schei","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"T H","family":"Edna","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[1999,6,1]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"273","DOI":"10.1093\/ageing\/25.4.273","article-title":"New evidence on benzodiazepine use and falls; The time factor","volume":"25","author":"Neutel, C.I.; Hirdes, J.P.; Maxwell, C.J.","year":"1996","unstructured":"Neutel CI, Hirdes JP, Maxwell CJ, et al. 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Arch Intern Med"},{"key":"ref_4","first-page":"599","article-title":"Falla as risk factors for fractors","author":"Grisso, J.A.; Capezuti, E.; Schwartz, A.","year":"1996","unstructured":"Grisso JA, Capezuti E, Schwartz A. Falla as risk factors for fractors. In: Marcus R, Feldman D, Kelsey J, eds. Osteoporosis. San Diego: Academic Press, 1996:599\u2013611."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"145","DOI":"10.1016\/S0140-6736(96)01440-7","article-title":"Fall-related factors and risk of hip fracture: the EPIDOS prospective study","volume":"348","author":"Dargent-Molina, P.; Favier, F.; Grandjean, H.","year":"1996","unstructured":"Dargent-Molina P, Favier F, Grandjean H, et al. Fall-related factors and risk of hip fracture: the EPIDOS prospective study. 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Fremmotet og sammenlikning av dem som m\u00f8tte og dem som ikke m\u00f8tte","volume":"110","author":"Holmen, J.; Midthjell, K.; Fors\u00e9n, L.","year":"1990","unstructured":"Holmen J, Midthjell K, Fors\u00e9n L, et al. [A health survey in Nord-Trondelag 1984\u201386. Participation and comparison of attendants and non-attendants] Helseundersokelsen i Nord-Trondelag 1984\u201386. Fremmotet og sammenlikning av dem som m\u00f8tte og dem som ikke m\u00f8tte. Tidsskr Nor Laegeforen 1990;110:1973\u201377."},{"key":"ref_13","first-page":"1","article-title":"A comparison between those who attended and those who did not attend the health screening in Nord-Tr\u00a2ndelag 1984\u201386 (in Norwegian)","author":"Holmen, J.; Fors\u00e9n, L.; Skjerve, K.","year":"1989","unstructured":"Holmen J, Fors\u00e9n L, Skjerve K, et al. A comparison between those who attended and those who did not attend the health screening in Nord-Tr\u00a2ndelag 1984\u201386 (in Norwegian). Report no.5. Verdal, Norway: SIFF, Avdeling for helsetjenesteforskning (Unit for Health Services Research), 1989;1\u2013156"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1671","DOI":"10.1002\/jbmr.5650091102","article-title":"Interaction between current smoking, leanness, and physical inactivity in the prediction of hip fracture","volume":"9","author":"Fors\u00e9n, L.; Bj\u00a2rndal, A.; Bjartveit, K.","year":"1994","unstructured":"Fors\u00e9n L, Bj\u00a2rndal A, Bjartveit K, et al. Interaction between current smoking, leanness, and physical inactivity in the prediction of hip fracture. J Bone Miner Res 1994;9:1671\u20138.","journal-title":"J Bone Miner Res"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1481","DOI":"10.2105\/AJPH.88.10.1481","article-title":"Ex-smokers and risk of hip fracture","volume":"88","author":"Fors\u00e9n, L.; Bjartveit, K.; Bj\u00a2rndal, A.","year":"1998","unstructured":"Fors\u00e9n L, Bjartveit K, Bj\u00a2rndal A, et al. Ex-smokers and risk of hip fracture. Am J Public Health 1998;88:1481\u20133.","journal-title":"Am J Public Health"},{"key":"ref_16","first-page":"1","article-title":"Modern epidemiology","author":"Rothman, K.J.","year":"1986","unstructured":"Rothman KJ. Modern epidemiology. Boston: Little, Brown, 1986:1\u2013358."},{"key":"ref_17","first-page":"1","article-title":"Principal component analysis","author":"Dunteman, G.H.","year":"1989","unstructured":"Dunteman GH. Principal component analysis. Newbury Park, CA: SAGE Publications, 1989:1\u201396."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"61","DOI":"10.1016\/B978-0-12-590241-0.50007-1","article-title":"Measures of subjective wellbeing","volume-title":"Measures of personality and social psychological attitudes","author":"Andrews, F.M.; Robinson, J.P.","year":"1991","unstructured":"Andrews FM, Robinson JP. Measures of subjective wellbeing. In: Robinson JP, Shaver PR, Wrightsman LS, eds. Measures of personality and social psychological attitudes. San Diego: Academic Press, 1991:61\u2013114."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"183","DOI":"10.1016\/0165-0327(93)90006-6","article-title":"Low genetic eVect and age-specific family eVect for symptoms of anxiety and depression in nuclear families, halfsibs and twins","volume":"27","author":"Tambs, K.; Moum, T.","year":"1993","unstructured":"Tambs K, Moum T. Low genetic eVect and age-specific family eVect for symptoms of anxiety and depression in nuclear families, halfsibs and twins. J AVect Disord 1993;27:183\u201395.","journal-title":"J AVect Disord"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"179","DOI":"10.1177\/140349489502300308","article-title":"Diabetes mellitus and psychological well-being. Results of the Nord-Tr\u00a2ndelag health survey","volume":"23","author":"N\u00e6ss, S.; Midthjell, K.; Moum, T.","year":"1995","unstructured":"N\u00e6ss S, Midthjell K, Moum T, et al. Diabetes mellitus and psychological well-being. Results of the Nord-Tr\u00a2ndelag health survey. Scand J Soc Med 1995;23:179\u201388.","journal-title":"Scand J Soc Med"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1002\/bs.3830190102","article-title":"The Hopkins Symptom Check List (HSCL). A self-report symptom inventory","volume":"19","author":"Derogatis, L.R.; Lipman, R.S.; Richels, E.H.","year":"1974","unstructured":"Derogatis LR, Lipman RS, Richels EH, et al. The Hopkins Symptom Check List (HSCL). A self-report symptom inventory. Behav Sci 1974;19:1\u201315.","journal-title":"Behav Sci"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"239","DOI":"10.1007\/BF01774013","article-title":"Risk factors for hip fracture in a high incidence area: a case-control study from Oslo, Norway","volume":"5","author":"Meyer, H.E.; Henriksen, T.B.; Falch, J.A.","year":"1995","unstructured":"Meyer HE, Henriksen TB, Falch JA, et al. Risk factors for hip fracture in a high incidence area: a case-control study from Oslo, Norway. Osteoporos Int 1995;5:239\u201346.","journal-title":"Osteoporos Int"},{"key":"ref_23","first-page":"61","article-title":"Stress, endocrine manifestations, and diseases","volume-title":"Handbook of stress, medicine, and health","author":"Tsigos, C.; Chrousos, G.P.","year":"1996","unstructured":"Tsigos C, Chrousos GP. Stress, endocrine manifestations, and diseases. In: Cooper LC, ed. Handbook of stress, medicine, and health. Boca Raton: CRC Press, 1996:61\u201385."},{"key":"ref_24","first-page":"359","author":"osteoporosis. In, Papapoulos S.E.Glucocorticoid-induced","year":"1996","unstructured":"Papapoulos SE. Glucocorticoid-induced osteoporosis. In: Papapoulos SE, Lips P, Pols HAE, et al, eds. Osteoporosis 1996. Amsterdam: Elsevier, 1996:359\u201367.","journal-title":"Osteoporosis"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"397","DOI":"10.1677\/joe.0.1490397","article-title":"Cortisol decreases IGF-I mRNA levels in human osteoblast-like cells","volume":"149","author":"Swolin, D.; Brantsing, C.; Matejka, G.","year":"1996","unstructured":"Swolin D, Brantsing C, Matejka G, et al. Cortisol decreases IGF-I mRNA levels in human osteoblast-like cells. J Endocrinol 1996;149:397\u2013403.","journal-title":"J Endocrinol"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"455","DOI":"10.1016\/8756-3282(95)00279-1","article-title":"Histomorphometric and biochemical characterization of bone following acute severe burns in children","volume":"17","author":"Klein, G.L.; Herndon, D.N.; Goodman, W.G.","year":"1995","unstructured":"Klein GL, Herndon DN, Goodman WG, et al. Histomorphometric and biochemical characterization of bone following acute severe burns in children. 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