Investigation of depressive symptoms in postmenopausal women with osteoporosis, specialized psychological nursing intervention measures, and key point analysis

Abstract

BACKGROUND

Postmenopausal women with osteoporosis are at high risk of developing depressive symptoms, necessitating specialized psychological nursing interventions.

AIM

To investigate factors influencing depressive symptoms in postmenopausal women with osteoporosis and develop targeted psychological nursing interventions.

METHODS

A total of 180 postmenopausal women with osteoporosis admitted to the Department of Orthopedics at the First Affiliated Hospital of Soochow University between October 2021 and October 2024 were selected as research participants. Information on age, duration of menopause, body mass index, education level, marital status, activity intensity, bone density, presence of chronic diseases, calcium supplement intake, sex hormone levels, and depressive symptoms were collected. The 24-item Hamilton Depression Scale was used for assessment.

RESULTS

Forty-eight patients had no depressive symptoms, and 132 patients had depressive symptoms. Comprehensive univariate and multivariate logistic regression analyses showed that low bone density in the lumbar spine (L2-L4) and femoral neck, presence of chronic diseases, and low 5-hydroxytryptamine levels were independent risk factors for depressive symptoms, whereas calcium supplement intake and moderate to high-intensity activity were independent protective factors.

CONCLUSION

By implementing specialized psychological nursing interventions, and providing rehabilitation guidance, the incidence of depressive symptoms can be effectively reduced, improving the psychological health status and patient quality of life.

Key Words: Menopause; Osteoporosis; Depression; Investigation; Specialized psychological nursing

Core Tip: Depressive symptoms in postmenopausal women with osteoporosis are influenced by multiple factors, including bone density, presence of chronic diseases, and 5-hydroxytryptamine levels. Specialized psychological nursing intervention measures can effectively reduce the risk of occurrence.

INTRODUCTION

In postmenopausal women, the decline in estrogen levels disrupts the balance of bone metabolism, leading to increased bone resorption and decreased bone formation, which significantly increases the incidence of osteoporosis and subsequently triggers a series of physical and psychological issues[1,2]. Women with postmenopausal osteoporosis face chronic pain, limited mobility, a decline in quality of life, and significant concerns about the prognosis of their disease. The incidence of depressive symptoms is higher in this population compared to the general population, and this can further exacerbate the condition of osteoporosis, creating a vicious cycle. This affects their daily life and lead to a deterioration in social functioning[3,4]. Therefore, it is particularly important to assess and intervene in the psychological state of this specific group, helping them establish a positive attitude towards life, effectively alleviating depressive symptoms, improving adherence to treatment, and thereby improving their overall health status and quality of life[5,6]. In light of this, this study conducted a survey and analysis of 180 postmenopausal women with osteoporosis admitted to the Department of Orthopedics at the First Affiliated Hospital of Soochow University, aiming to explore the factors influencing the occurrence of depressive symptoms and develop targeted specialized psychological nursing intervention measures.

MATERIALS AND METHODS

General information

A total of 180 postmenopausal women with osteoporosis admitted to the Department of Orthopedics at the First Affiliated Hospital of Soochow University between October 2021 and October 2024 were included in this study. This study was approved by the hospital ethics committee. The inclusion criteria were as follows: (1) Age 45–75 years; (2) Confirmed diagnosis of postmenopausal osteoporosis; (3) Ability to understand and voluntarily sign the informed consent form; and (4) Complete clinical data. The exclusion criteria were as follows: (1) Presence of psychiatric disorders or cognitive dysfunction; (2) Present antidepressant treatment; (3) Presence of malignant tumors, severe cardiovascular and cerebrovascular diseases, or other serious complications; and (4) Recent experience of significant life events or traumatic experiences.

Methods

Data collection: Before enrollment, all the patients underwent detailed medical history inquiries, physical examinations, and laboratory tests. Data including age, menopause duration, body mass index (BMI), education level, marital status, activity intensity, bone density, chronic diseases, calcium intake, sex hormone levels, and depressive symptoms were collected from medical records, interviews, and imaging data. The bone density values of the lumbar spine (L2-L4), hip, and femoral neck were measured using dual-energy X-ray absorptiometry. Sex hormone levels were assessed by drawing venous blood and using radioimmunoassays to measure follicle-stimulating hormone (FSH), luteinizing hormone (LH), estradiol (E2), progesterone, and serotonin [5-hydroxytryptamine (5-HT)] levels.

Depressive symptom assessment: The 24-item Hamilton Depression Scale (HAMD) was used for assessment, with higher total scores indicating more severe depressive symptoms. According to the cutoff score, patients with HAMD scores ≤ 8 were classified as having no depressive symptoms, and those with HAMD scores > 8 were classified as having depressive symptoms.

Statistical analysis

Data were analyzed using Statistical Package for the Social Sciences 24.0. Count data are expressed as percentages (%) and analyzed using the χ² test. Continuous data were normally distributed as confirmed by the Shapiro-Wilk test and are expressed as mean ± SD, analyzed using the t-test. Differences were considered statistically significant at P < 0.05. Variables with statistical significance in the univariate analysis were included in the multivariate logistic regression analysis to identify the independent influencing factors.

RESULTS

Depressive symptom status

Among the 180 postmenopausal women with osteoporosis, 48 (26.67%) had no depressive symptoms (HAMD score ≤ 8), and 132 (73.33%) had depressive symptoms (HAMD score > 8).

Univariate analysis of depressive symptoms in postmenopausal women with osteoporosis

The results indicate that there are no significant differences between the two groups in terms of age, menopausal years, BMI, FSH, LH, or progesterone levels (P > 0.05). However, significant differences were observed in education level (P = 0.089, approaching significance), marital status (P = 0.150), activity intensity (P = 0.022), bone mineral density at the lumbar spine (P < 0.001), hip (P < 0.001), and collum femoris (P < 0.001), presence of combined chronic diseases (P = 0.019), calcium tablet intake (P = 0.006), E2 levels (P < 0.001), and 5-HT levels (P < 0.001). These findings suggest that lower physical activity intensity, lower bone mineral density, higher prevalence of chronic diseases, lower calcium intake, lower E2 levels, and lower serotonin levels may be associated with an increased risk of depression in postmenopausal women with osteoporosis (Table 1).

Table 1 Univariate analysis of depressed mood in women with postmenopausal osteoporosis, n (%).

Variables	Depression (n = 132)	Normal (n = 48)	t/χ² value	P value
Age	62.40 ± 5.31	61.58 ± 5.28	0.918	0.360
Menopausal years	14.26 ± 3.75	13.59 ± 3.84	1.053	0.293
Body mass index (kg/m2)	24.35 ± 1.27	24.10 ± 1.23	1.178	0.240
Degree of education
Primary school and below	103 (78.03)	30 (62.50)
Junior middle school	22 (16.67)	15 (31.25)	4.848	0.089
High school and above	7 (5.30)	3 (6.25)
Marital status
Single/widowed	42 (31.82)	10 (20.83)	2.068	0.150
In marriage	90 (68.18)	38 (79.17)
Activity intensity
Low strength	75 (56.82)	18 (37.50)	5.260	0.022
Medium and high intensity	57 (43.18)	30 (62.50)
Bone mineral density (g/cm2)
Lumbar spine L2-L4	0.55 ± 0.12	0.64 ± 0.13	4.351	< 0.001
Hip	0.60 ± 0.13	0.68 ± 0.14	3.576	< 0.001
Collum femoris	0.57 ± 0.11	0.65 ± 0.12	4.211	< 0.001
Combined chronic diseases
Yes	81 (61.36)	20 (41.67)	5.545	0.019
No	51 (38.64)	28 (58.33)
Taking calcium tablets
Yes	78 (59.09)	39 (81.25)	7.597	0.006
No	54 (40.91)	9 (18.75)
Sex hormone levels
Follicle-stimulating hormone (mIU/mL)	25.14 ± 3.28	24.96 ± 3.37	0.323	0.747
Luteinizing hormone (mIU/mL)	18.87 ± 2.59	18.96 ± 2.45	0.209	0.835
Estradiol (pg/mL)	24.46 ± 5.11	28.24 ± 5.39	4.325	< 0.001
Progesterone (ng/mL)	2.19 ± 0.52	2.16 ± 0.48	0.349	0.727
5-hydroxytryptamine (μg/mL)	25.79 ± 3.53	30.54 ± 3.82	7.809	< 0.001

Bone mineral density (g/cm²) was measured at the lumbar spine (L2-L4), hip, and collum femoris (femoral neck).

Multivariate logistic regression analysis of depressed mood in women with postmenopausal osteoporosis

Table 2 presents the results of a multivariate logistic regression analysis examining the factors associated with depressed mood in women with postmenopausal osteoporosis. The analysis includes eight potential risk factors: (1) Lumbar spine L2-L4 bone mineral density (BMD); (2) Hip BMD; (3) Femoral neck BMD; (4) Presence of combined chronic diseases; (5) Calcium tablet intake; (6) Physical activity intensity; (7) E2 levels; and (8) 5-HT levels.

Table 2 Multivariate logistic regression analysis of depressed mood in women with postmenopausal osteoporosis.

Factor	Beta	Sb	Wald χ² value	P value	Odds ratio	95%CI
Lumbar spine L2-L4 bone mineral density ≤ 0.60 g/cm2	0.665	0.427	3.116	0.039	1.796	1.082-2.053
Hip bone mineral density of 0.65 g/cm2	0.629	0.438	2.708	0.226	1.543	0.952-1.853
Bone density of femoral neck ≤ 0.60 g/cm2	0.533	0.326	3.356	0.040	1.634	1.145-1.991
Combined chronic diseases	0.835	0.367	4.195	0.015	1.857	1.187-3.025
Take calcium tablets	-0.923	0.554	3.371	0.024	0.599	0.308-0.857
Medium and high intensity activities	-0.782	0.451	2.584	0.032	0.611	0.359-0.916
Estradiol ≤ 26.0 pg/mL	0.725	0.760	2.429	0.092	1.357	0.917-1.746
5-hydroxytryptamine ≤ 28.0 μg/mL	0.483	0.571	1.987	0.036	1.405	1.035-2.929

DISCUSSION

Occurrence of depressive symptoms in postmenopausal women with osteoporosis

In postmenopausal women, a decline in estrogen levels can lead to an imbalance in neurotransmitters, thereby affecting brain function and resulting in symptoms such as low mood, sleep disturbances, reduced interest, fatigue, decreased self-esteem, hot flashes, and difficulty concentrating. These symptoms can further affect emotional stability, making postmenopausal women a high-risk group for depressive symptoms[7,8]. Additionally, this population often experiences pain and limited mobility due to the condition, which significantly affect their quality of life. They may also reduce their social activities because of concerns about the risk of fractures, leading to decreased social support, which can trigger depressive symptoms[9,10]. In this study, among 180 postmenopausal women with osteoporosis, 73.33% had depressive symptoms (HAMD score > 8), highlighting the strong prevalence of depressive symptoms in this patient population and emphasizing the need for adequate attention and importance.

Influencing factors of depressive symptoms in postmenopausal women with osteoporosis

The analyses showed that low bone density in the lumbar spine (L2-L4) and femoral neck, having a chronic disease, and low 5-HT levels were risk factors for depression in postmenopausal women with osteoporosis (P < 0.05). Meanwhile, taking calcium supplements and engaging in moderate-to high-intensity physical activity could protect against depression (P < 0.05). A deeper analysis of these factors suggests that the decrease in bone density, particularly in the lumbar spine and femoral neck, not only reflects a deterioration in skeletal health but may also affect the physical function and mobility of patients, thereby significantly impacting their mental health[11,12]. Postmenopausal women with osteoporosis who have chronic diseases may experience increased psychological stress and reduced quality of life owing to the long-term burden of illness and discomfort from treatment, which can subsequently affect their emotional state[13,14]. The 5-HT is a neurotransmitter that plays multiple key roles in the body and is extensively involved in regulating emotions, sleep patterns, and appetite control. Changes in its levels are closely associated with mental health issues, such as depression and anxiety, influencing psychological well-being and overall happiness, and are essential for maintaining the physical and mental health[15,16]. The negative correlation between calcium supplementation and depressive symptoms may be because calcium is important for skeletal health. Adequate calcium supplementation can help improve osteoporosis symptoms, thereby positively affecting the mental health[17,18]. Postmenopausal women with osteoporosis who engage in moderate-to-high-intensity physical activity have a lower incidence of depressive symptoms. This may be because physical activity promotes the secretion of endorphins, improves mood, enhances physical fitness, and reduces osteoporosis symptoms, thus positively affecting the mental health[19,20].

Specialized psychological nursing interventions and key points for postmenopausal women with osteoporosis

The survey found that the main risk factors for depressive symptoms in postmenopausal women with osteoporosis were low bone density in the lumbar spine (L2-L4) and femoral neck, presence of chronic diseases, and low levels of 5-HT. Taking calcium supplements and engaging in moderate-to high-intensity physical activity were beneficial for reducing the risk of depressive symptoms. Therefore, in clinical practice, it is essential to consider the individual differences and implement personalized and multidimensional specialized psychological nursing interventions. The specific measures include the following: (1) Conducting mental health education to help patients correctly understand postmenopausal osteoporosis and its potential impact on mental health, enhancing their knowledge of the disease, self-management capabilities, and confidence in coping with the condition; (2) Providing psychological support and counseling through one-on-one conversations or group discussions to help patients deal with psychological stress related to the disease, offering emotional support and encouragement, assisting them in establishing a positive social support network, learning coping strategies, changing negative thinking patterns and behaviors, reducing feelings of loneliness and helplessness, and alleviating depressive symptoms; (3) For patients with low bone density and chronic diseases, nursing staff should work with patients to develop personalized exercise plans, encouraging them to participate in appropriate physical activities such as walking, tai chi, yoga, and water aerobics to improve physical fitness, enhance bone density, and promote the secretion of endorphins, which can positively impact the mood and alleviate depressive symptoms; (4) Guiding patients to supplement calcium and other nutrients appropriately to improve osteoporosis symptoms and reduce the occurrence of depressive symptoms; (5) Monitoring patients' 5-HT levels, and for those with low 5-HT levels, considering the use of medications or supplements that can regulate 5-HT levels under the guidance of a physician, while ensuring adequate intake of vitamins and minerals, especially tryptophan-the precursor for 5-HT synthesis, to maintain it within a normal range, thereby positively affecting mental health; and (6) Lastly, for patients with limited mobility due to osteoporosis, nursing staff should provide professional rehabilitation guidance, including physical therapy and functional training, to improve their mobility, reduce dependence on daily life, and enhance their quality of life.

Through these comprehensive psychological nursing interventions, the incidence or severity of depressive symptoms in postmenopausal women with osteoporosis can be effectively reduced, thereby improving their overall health status and quality of life. The proposed specialized psychological nursing interventions for postmenopausal women with osteoporosis may face several challenges in clinical practice. First, personalized exercise plans for patients with low bone density or chronic diseases may be limited by factors such as their physical conditions, availability of sports venues and equipment, and socioeconomic status. To address this, healthcare providers could collaborate with community healthcare resources to provide accessible and cost-effective exercise alternatives. Second, the use of medications or supplements to regulate 5-HT levels may involve potential side effects and drug interactions. Therefore, it is crucial to conduct thorough assessments of patients' medical histories and provide strict monitoring under medical supervision. Multidisciplinary collaboration between psychiatrists and orthopedic specialists can enhance the safety and effectiveness of such interventions. Furthermore, the implementation of these interventions may require significant time and resources for patient education and follow-up. To mitigate this, healthcare teams can utilize digital health tools, such as telemedicine platforms, to deliver educational content and conduct remote monitoring. Despite these challenges, the integration of these interventions into routine clinical care holds promise for improving the mental health of postmenopausal women with osteoporosis and can serve as a foundation for future research and practice in this area.

CONCLUSION

Depressive symptoms are common among postmenopausal women with osteoporosis and are closely related to factors such as bone density, chronic diseases, and 5-HT levels. By implementing specialized psychological nursing interventions, including mental health education, psychological support, personalized exercise plans, appropriate calcium and nutrient supplementation, monitoring and adjusting 5-HT levels, and providing rehabilitation guidance, the incidence of depressive symptoms can be effectively reduced, thereby improving patients’ psychological health status and quality of life.