Combined effect of living alone and osteoporosis status on the prevalence of depression in Chinese community-dwelling older population: a cross-sectional study

Background: Given the increasing burden of the "silent" depressive symptoms and the significant comorbidity of osteoporosis in the population living alone, this study aimed to investigate the separate and combined impacts of living alone and osteoporosis on the prevalence of depression in the older Chinese population. Methods: A total of 4,240 Chinese suburban-dwelling older individuals (mean age: 71.75 ± 5.88 years; 58.0% women) aged ≥60 years were recruited. Living arrangements were assessed by a questionnaire. Participants with a T score less than or equal to -2.5 were identified as osteoporosis. Participants were categorized into four groups based on their living status and osteoporosis prevalence: living with others and non-osteoporosis; living with others and osteoporosis; living alone and non-osteoporosis and living alone and osteoporosis groups. Depression was assessed by the Chinese version of Geriatric Depressive symptoms Scale (GDS). Results: 515 (12.1%) were measured to have depressive symptoms (141 males and 374 females). In males, a significant association with depression only existed in the combined group of living alone and osteoporosis (OR = 3.61, 95%CI = 1.78-7.30). However, living alone with or without osteoporosis showed a significantly higher prevalence of depression in females (OR = 2.11, 95%CI = 1.34-3.31; OR = 2.21, 95%CI = 1.44-3.39, respectively). Conclusion: Osteoporosis by itself had no significant association with depression. However, the combination of living alone and osteoporosis was significantly associated with a higher prevalence of depression, especially in males. This study highlights the critical need for early identification and appropriate intervention for osteoporosis among older individuals living alone.