Poor Sleep Quality and Short Sleep Duration Associated With Increased Risk for Osteoporosis

elderly woman can't sleep
elderly woman can’t sleep
Using the 2005 to 2010 NHANES, the researchers examined the association between osteoporosis risk and the effect of sleep quality and duration in adults.

Short sleep duration and poor sleep quality are significant risk factors for osteoporosis among women aged 50 years and older, according to study results published in Scientific Reports.

There are mixed data on the association between bone health and sleep quality and duration. In previous studies, the effect of sleep on bone density varied depending on the definitions, selected population, and diagnostic tool.

The objective of the current cross-sectional study was to determine the association between sleep duration and quality and risk for osteoporosis in adults, using the 2005 to 2010 National Health and Nutrition Examination Survey (NHANES), a national household survey.

Duration of sleep was determined according to a single question in the NHANES (“How much sleep do you usually get at night on weekdays or workdays?”), and sleep duration was analyzed as both a continuous and a categorical variable: very short (1-4 h/day); short (5-6 h/day), average (7-8 h/day), and long (>9 h/day). Sleep quality was also defined by 2 questions (“Ever told a doctor had trouble sleeping?” and “Ever told by doctor have sleep disorder?”). Dual-energy x-ray absorptiometry was used to determine bone mineral density (BMD) and diagnosis of osteoporosis, low BMD, or normal bone density based on T-score over femoral neck.

The study sample included 12,793 (mean age, 46.25 years; 50% men) patients. Most patients (54.2%) had a sleep duration of 7 to 8 hours/day, followed by sleep duration of 5 to 6 hours per day (33.2%), and 1 to 4 hours per day (5.6%). While sleep duration was not different according to age or race, men had shorter sleep duration compared with women (6.8 vs 7.0 h/day, respectively).

Among women aged 50 years and older, sleep duration less than 5 hours per day was associated with a 7-fold greater risk for osteoporosis (odds ratio [OR], 7.35; 95% CI, 3.438-15.715) and the OR for low BMD was 3.002 (95% CI, 1.828-4.932). Poor sleep quality was associated with a 5-fold greater risk for osteoporosis (OR, 5.57; 95% CI, 1.60-19.41).

The study had several limitations, including the cross-sectional design that limited the ability to determine causality, the use of hip BMD but not the lumbar spine BMD, and the use of self-reported data on sleep parameters.

“Our findings add to the current body of knowledge regarding relationships between bone health and the combined effect of sleep duration and gender. In future research, it is important to assess the potential causal effects of this association beyond the dimensions of the cross-sectional design,” the researchers concluded.


Lee C-L, Tzeng H-E, Liu W-J, Tsai C-H. A cross-sectional analysis of the association between sleep duration and osteoporosis risk in adults using 2005-2010 NHANES. Sci Rep. 2021;11(1):9090. doi:10.1038/s41598-021-88739-x