Open Access Research article

Depression after low-energy fracture in older women predicts future falls: a prospective observational study

Martha van den Berg1*, Noortje A Verdijk2, Geraline L Leusink3, Colette JM Wijnands-van Gent4, Arnold C Romeijnders4, Victor JM Pop1 and Joop PW van den Bergh56

Author Affiliations

1 Tilburg University, CoRPS - Center of Research on Psychology in Somatic diseases, PO Box 90153, 5000 LE Tilburg, the Netherlands

2 Diagnostiek voor U, PO Box 2406, 5600 CK Eindhoven, the Netherlands

3 Stichting Severinus, PO Box 6666, 5500 MA Veldhoven, the Netherlands

4 PoZoB, Coordination Centre of Practice Nurses for South East Netherlands, PO Box 312, 5500 AH Veldhoven, the Netherlands

5 VieCuri Medical Centre Noord-Limburg, Department of Internal Medicine, PO Box 1926, 5900 BX Venlo, the Netherlands

6 Maastricht University/Nutrim, Faculty of Health Medicine and Life Science, Department of Internal Medicine, PO Box 616, 6200 MD Maastricht, the Netherlands

For all author emails, please log on.

BMC Geriatrics 2011, 11:73  doi:10.1186/1471-2318-11-73

Published: 7 November 2011



Falls are one of the main causes of fractures in elderly people and after a recent fracture, the risk of another fall is increased, resulting in subsequent fracture. Therefore, risk factors for future falls should be determined. We prospectively investigated the relationship between depression and the incidence of falls in post-menopausal women after a low-energy fracture.


At baseline, 181 women aged 60 years and older who presented with a recent low-energy fracture were evaluated at the fracture and osteoporosis outpatient clinics of two hospitals. As well as clinical evaluation and bone mineral density tests, the presence of depression (measured using the Edinburgh Depression Scale, EDS, depression cut-off > 11) and risk factors for falling were assessed. During two years of follow-up, the incidence of falls was registered annually by means of detailed questionnaires and interviews.


Seventy-nine (44%) of the women sustained at least one fall during follow-up. Of these, 28% (n = 22) suffered from depression at baseline compared to 10% (n = 10) of the 102 women who did not sustain a fall during follow-up (Χ2 = 8.76, df = 1, p = .003). Multiple logistic regression showed that the presence of depression and co-morbidity at baseline were independently related to falls (OR = 4.13, 95% CI = 1.58-10.80; OR = 2.25, 95% CI = 1.11-4.56, respectively) during follow-up.


The presence of depression in women aged 60 years and older with recent low-energy fractures is an important risk factor for future falls. We propose that clinicians treating patients with recent low-energy fractures should anticipate not only on skeletal-related risk factors for fractures, but also on fall-related risk factors including depression.