Synergistic impact of depression and osteoporosis on cardiovascular and all-cause mortality: A cohort study based on NHANES data

Depression and osteoporosis are significant global health issues. Depression affects mental well-being and imposes social and economic burdens, while osteoporosis impacts bone health and raises fracture risk. However, their effects on cardiovascular disease (CVD) mortality and all-cause mortality remain unclear. This study examines their combined impact on cardiovascular and all-cause mortality. We used National Health and Nutrition Examination Survey data from 2005 to 2010, 2013 to 2014, and 2017 to 2018 (n = 19,282; weighted population 155,470,483). Depression was assessed via Patient Health Questionnaire-9, and osteoporosis through dual-energy X-ray absorptiometry scans. Mortality data came from the National Death Index. Participants were categorized into 4 groups based on depression and osteoporosis status. Cox models and Kaplan–Meier analysis were used to assess mortality risk. The primary outcomes were CVD mortality and all-cause mortality. During a median 122-month follow-up, there were 2384 all-cause deaths and 581 CVD deaths. The Dep+/OP+ group had the highest all-cause mortality risk (hazard ratio = 2.80, 95% confidence intervals: 1.92–4.08) and CVD mortality risk (hazard ratio = 2.03, 95% confidence intervals: 1.21–3.39). Compared to the Dep−/OP− group, the Dep−/OP+ and Dep+/OP− groups also had elevated risks. The combination of depression and osteoporosis significantly increases CVD and all-cause mortality risks, particularly in younger individuals and males. These conditions may share biological pathways that increase mortality risk, highlighting the need for integrated clinical management.