Sleep disturbance and bone mineral density, risk of falls and fracture:​ results from a 10.7-year prospective cohort study

Pan, Feng; Tian, Jing; Cicuttini, Flavia; Jones, Graeme

Affiliations

¹Menzies Institute for Medical Research, University of Tasmania, Private Bag 23, Hobart, Tasmania 7000, Australia

²Department of Epidemiology and Preventive Medicine, Monash University Medical School, Commercial Road, Melbourne, Victoria 3181, Australia

Abstract and keywords

Sleep problems are common in the general population and have been linked to bone health, falls risk and fracture. However, longitudinal studies on sleep-bone health outcomes are lacking and no study has investigated whether an increased risk of fracture is attributable to sleep-related low bone mineral density (BMD) and an increased risk of falls. This study was designed to examine the associations of sleep disturbance with bone mineral density (BMD), risk of falls and fractures over 10.7 years. The analyses were performed in a population-based cohort study with 1099 participants (mean age 62.9 years) enrolled at baseline, and 875, 768 and 563 participants traced at a mean follow-up of 2.6, 5.1 and 10.7 years, respectively. At each visit, self-reported sleep disturbance was recorded. BMD (by dual-energy x-ray absorptiometry), falls risk score and fracture were measured at each visit. The short-form Physiological Profile Assessment was used to measure falls risk score expressed as Z-score. Fractures were self-reported. Mixed-effects model and generalized estimating equations were used for the analyses. In multivariable analysis, there was a dose-response relationship between the extent of sleep disturbance and falls risk score with the strongest association in those reporting the worst sleep disturbance (β = 0.15/unit; 95%CI 0.02–0.28). The worst sleep disturbance was associated with an increased risk of any (relative risk [RR] 1.30/unit; 95%CI 1.01–1.67) and (RR 2.41/unit; 95%CI 1.00–5.80) compared with those reporting no interrupted sleep. Women but not men with sleep disturbance had a higher risk of vertebral fracture (RR: 2.07 to 6.02, P < 0.05). These were independent of covariates, hip BMD and falls risk. There was no statistically significant association between sleep disturbance and BMD at the hip, spine or total body. Sleep disturbance was independently associated with a greater falls risk score and an increased risk of fractures. Further research is needed to confirm and identify underlying mechanisms for these associations.

Keywords: Sleep; Bone mineral density; Falls; Fractures; Risk

Links

DOI: 10.1016/j.bone.2021.115938

PubMed: 33766805

WoS: 000643707100003

History

Received: 2021-01-24

Revised: 2021-03-19

Accepted: 2021-03-19

Online: 2021-03-23

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