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Inflammatory Cytokine Levels and Depressive Symptoms in Older Women in the Year After Hip Fracture: Findings from the Baltimore Hip Studies

Authors


  • Related paper presentations: Association Between Inflammatory Markers and Depressive Symptoms in Older Adults after Hip Fracture: The Baltimore Hip Studies, as part of the Baltimore Hip Studies Symposium at the 61st Annual Meeting of the Gerontological Society of America, November 2008.

Address correspondence to Maya E. Matheny, Division of Gerontology, Department of Epidemiology and Public Health, School of Medicine, University of Maryland 660 West Redwood Street, Suite 200, Baltimore, MD 21201. E-mail: mmatheny@epi.umaryland.edu

Abstract

Objectives

To determine whether interleukin (IL)-6 or soluble tumor necrosis factor alpha receptor 1 (sTNF-αR1) is associated with depressive symptoms in the year after hip fracture.

Design

Prospective cohort.

Setting

Three Baltimore-area hospitals.

Participants

Community-dwelling women aged 65 and older admitted with a new, nonpathological fracture of the proximal femur (N = 134).

Measurements

Two, 6, and 12 months after fracture, serum was analyzed for IL-6 and sTNF-αR1, and depressive symptoms were measured using the 15-item Geriatric Depression Scale (GDS). Generalized estimating equations were used to model the longitudinal relationship between IL-6, sTNF-αR1, and GDS score. Whether lower extremity function, as measured according to the Lower Extremity Gain Scale (LEGS), explained the relationship between IL-6, sTNF-αR1, and GDS score was also examined.

Results

Participants in the highest categories of IL-6 (≥5.14 pg/mL) and sTNF-αR1 (≥2,421 pg/mL) had the highest GDS scores in the year after fracture (= .09 for both). Twelve months after fracture, those in the highest IL-6 and sTNF-αR1 categories had GDS scores that were on average 1.9 (95% confidence interval (CI) = 0.4–3.4, = .01) and 1.4 (95% CI = −0.1–3.0, = .07) points higher than those in the lowest category, respectively. Adjusting for LEGS score, the mean difference in GDS scores for highest versus lowest IL-6 categories was 1.6 (95% CI = 0.2–3.0, = .02) points at 12 months.

Conclusion

Results from these exploratory analyses support a role for inflammation in the pathophysiology of depressive symptoms after hip fracture. Depressive symptoms in the context of high cytokine levels may represent a sickness syndrome that is chronic in some individuals. Further research should establish the cause and effect of this relationship, as well as long-term correlates.

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