Distinct Impacts of Somatic and Cognitive-Affective Depressive Symptom Trajectories on Osteoporosis Risk in Adults Aged 50 Years and Older

OBJECTIVES: To examine whether 8-year trajectories of total, cognitive-affective, and somatic depressive symptoms are associated with 10-year incident osteoporosis in adults aged 50 years and older. METHODS: We analyzed 2,816 participants from the English Longitudinal Study of Aging without osteoporosis at baseline or during the exposure period. Depressive symptoms were assessed across four waves using the 8-item Center for Epidemiologic Studies Depression Scale. Participants were classified into five predefined trajectories: consistently low, decreasing, increasing, consistently high, and fluctuating. Cox proportional hazards models were used to estimate hazard ratios and 95% confidence intervals. RESULTS: Compared with consistently low trajectories, decreasing and fluctuating total depressive symptom trajectories were associated with higher osteoporosis risk in fully adjusted models. For cognitive-affective symptoms, only the consistently high trajectory predicted incident osteoporosis. For somatic symptoms, both consistently high and fluctuating trajectories were independently associated with increased risk. CONCLUSIONS: Associations between depressive symptom trajectories and osteoporosis risk differed by symptom dimension. Total symptom trajectories showed more heterogeneous patterns after covariate adjustment, whereas domain-specific analyses revealed clearer associations, particularly for somatic symptoms. CLINICAL IMPLICATIONS: Monitoring persistent or fluctuating somatic depressive symptoms may help identify older adults who could warrant closer attention to osteoporosis risk assessment and preventive counseling.