{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,28]],"date-time":"2026-08-28T14:31:48Z","timestamp":1787927508515,"version":"build-2784847793"},"reference-count":26,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"1","license":[{"start":{"date-parts":[[2026,5,1]],"date-time":"2026-05-01T00:00:00Z","timestamp":1777593600000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Evidence on depressive symptoms and skeletal health is largely cross-sectional and rarely addresses competing risk, dose-response, or potential behavioral pathways. We examined the association between baseline depressive symptoms and incident osteoporosis in older adults, accounting for competing mortality and exploring mediation by physical activity.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Materials and Methods:<\/jats:title>\n                    <jats:p>We analyzed 4920 adults aged \u2265 60 years from the English Longitudinal Study of Ageing with Wave 1 8-item Center for Epidemiologic Studies Depression Scale (CES-D-8) scores and follow-up osteoporosis ascertainment. Incident physician-diagnosed osteoporosis was the outcome. Cox models estimated hazard ratios (HRs) per 1-point higher CES-D-8 score. Restricted cubic splines assessed dose-response, Fine\u2013Gray models accounted for death as a competing event, and exploratory natural-effects models assessed baseline physical activity as a potential mediator.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      During a median follow-up of 16.0 years, 502 participants developed incident osteoporosis and 1138 deaths occurred. Higher CES-D-8 scores were associated with greater osteoporosis risk in the fully adjusted Cox model (HR, 1.05; 95% confidence interval [CI], 1.01\u20131.10;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = 0.020), with consistent results in Fine\u2013Gray models (subdistribution HR, 1.05; 95% CI, 1.01\u20131.10;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = 0.019). The dose\u2013response appeared approximately linear. Exploratory subgroup analyses did not show robust effect modification, and mediation by baseline physical activity was not statistically supported.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>Baseline depressive symptoms were associated with a small increase in incident osteoporosis risk among older adults. The individual-level effect size was modest, and mediation findings should be interpreted as exploratory rather than causal.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.4103\/jrms.jrms_1210_25","type":"journal-article","created":{"date-parts":[[2026,8,28]],"date-time":"2026-08-28T14:07:24Z","timestamp":1787926044000},"update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":0,"title":["Depressive symptoms and incident osteoporosis in older adults: A cohort study with competing-risk and mediation analyses in English Longitudinal Study of Aging"],"prefix":"10.4103","volume":"31","author":[{"given":"Zhikun","family":"Wei","sequence":"first","affiliation":[{"name":"Department of Orthopaedic Traumatology and Hand Surgery, The First Affiliated Hospital to Guangxi Medical University, Nanning, China"},{"name":"Department of Orthopaedics Trauma, Handan First Hospital, Handan, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jianwen","family":"Cheng","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Traumatology and Hand Surgery, The First Affiliated Hospital to Guangxi Medical University, Nanning, China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2026,5]]},"reference":[{"key":"R1-20260828","doi-asserted-by":"crossref","first-page":"182","DOI":"10.7326\/M22-0684","article-title":"Effectiveness and safety of treatments to prevent fractures in people with low bone mass or primary osteoporosis: A living systematic review and network meta-analysis for the American college of physicians","volume":"176","author":"Ayers","year":"2023","journal-title":"Ann Intern Med"},{"key":"R2-20260828","doi-asserted-by":"crossref","first-page":"e873","DOI":"10.1016\/S2665-9913(25)00105-5","article-title":"The global, regional, and national burden attributable to low bone 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