Functional status and depressive symptoms in relation to bone mineral density and osteoporosis in hospitalized older adults: a cross-sectional study

Abstract

Osteoporosis is a major cause of morbidity and fractures among older adults, contributing substantially to disability, hospitalization, and mortality. This cross-sectional study investigated the associations of depressive symptoms and functional status with bone mineral density (BMD) and osteoporosis in hospitalized older adults. We analyzed 1,048 hospitalized patients aged ≥ 70 years who underwent dual-energy X-ray absorptiometry (DXA). Depressive symptoms (GDS-15) and functional status (Barthel Index) were extracted from routine geriatric assessments. Group comparisons, multivariable linear regression, and logistic regression analyses were performed after adjustment for demographic, clinical, and endocrine covariates. Lower Barthel Index scores and higher depressive symptom burden were independently associated with lower hip BMD, whereas associations with lumbar spine BMD were less consistent. Although statistically significant, the observed effect sizes were modest. The multivariable model explained a moderate proportion of BMD variability (adjusted R² = 0.22). Functional and psychological characteristics were independently associated with bone mineral density in hospitalized older adults. Given the cross-sectional design, causal relationships cannot be established. These findings support the potential value of incorporating comprehensive geriatric assessment into osteoporosis evaluation to improve identification of older adults at increased fracture risk.