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Osteoporosis International

, Volume 29, Issue 8, pp 1689–1695 | Cite as

Sleep duration and the risk of osteoporosis among middle-aged and elderly adults: a dose-response meta-analysis

  • D. Wang
  • W. Ruan
  • Y. Peng
  • W. LiEmail author
Review

Abstract

It remains unclear how many hours of sleep are associated with the lowest risk of osteoporosis. This meta-analysis was performed to assess the dose-response relationship between sleep duration and risk of osteoporosis. PubMed and Web of Science were searched from inception to December 3, 2017, supplemented by manual searches of the bibliographies of retrieved articles. Data were pooled using fixed- and random-effects models. Restricted cubic spline analysis with four knots was used to model the sleep duration and osteoporosis association. Four cross-sectional studies with eight records were eligible for inclusion in the meta-analysis. A U-shaped dose-response relationship was observed between sleep duration and risk of osteoporosis, with the lowest risk observed at a sleep duration category of 8–9 h per day. Compared with 8-h sleep duration per day, the pooled odds ratio for osteoporosis were 1.03 (95% CI 1.01–1.06) for each 1-h reduction among individuals with shorter sleep duration and 1.01 (95% CI 1.00–1.02) for each 1-h increment among individuals with longer sleep duration. Our dose-response meta-analysis shows a U-shaped relationship between sleep duration and risk of osteoporosis, with the lowest osteoporosis risk at about 8 h per day of sleep duration. Both short and long sleep duration is associated with a significantly increased risk of osteoporosis in the middle-aged and elderly adults, appropriate sleep duration could help for delay or prevention of osteoporosis.

Keywords

Dose-response Meta-analysis Osteoporosis Sleep duration 

Notes

Funding

This work was funded by the China Postdoctoral Science Foundation funded project (2017M622466). The funder had no role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Compliance with ethical standards

Conflicts of interest

None.

Supplementary material

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ESM 1 (DOCX 14.2 kb)
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Fig. S1

Dose-response relationship plot between long sleep duration and risk of osteoporosis (JPEG 38.1 KB)

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Fig. S2

Dose-response relationship plot between short sleep duration and risk of osteoporosis (JPEG 42.8 KB)

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Fig. S3

Begg’s funnel plot for studies of long sleep duration in relation to osteoporosis risk (JPEG 59.7 KB)

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Fig. S4

Begg’s funnel plot for studies of short sleep duration in relation to osteoporosis risk (JPEG 59.8 KB)

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Fig. S5

Sensitivity analysis plot to evaluate the effect of each study on the overall long sleep duration and osteoporosis risk (JPEG 74.0 KB)

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Fig. S6

Sensitivity analysis plot to evaluate the effect of each study on the overall short sleep duration and osteoporosis risk (JPEG 65.7 KB)

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References

  1. 1.
    (1993) Consensus development conference: diagnosis, prophylaxis, and treatment of osteoporosis. Am J Med 94:646–650Google Scholar
  2. 2.
    (2013) Bone care for the postmenopausal woman International Osteoporosis Foundation, http://share.iofbonehealth.org/WOD/2013/thematic-report/WOD13-Report.pdf
  3. 3.
    Cunningham TD, Di Pace BS (2015) Is self-reported sleep duration associated with osteoporosis? Data from a 4-year aggregated analysis from the National Health and Nutrition Examination Survey. J Am Geriatr Soc 63:1401–1406CrossRefPubMedGoogle Scholar
  4. 4.
    Shan Z, Ma H, Xie M, Yan P, Guo Y, Bao W, Rong Y, Jackson CL, Hu FB, Liu L (2015) Sleep duration and risk of type 2 diabetes: a meta-analysis of prospective studies. Diabetes Care 38:529–537CrossRefPubMedGoogle Scholar
  5. 5.
    Li W, Wang D, Cao S, Yin X, Gong Y, Gan Y, Zhou Y, Lu Z (2016) Sleep duration and risk of stroke events and stroke mortality: a systematic review and meta-analysis of prospective cohort studies. Int J Cardiol 223:870–876CrossRefPubMedGoogle Scholar
  6. 6.
    Kobayashi D, Takahashi O, Deshpande GA, Shimbo T, Fukui T (2012) Association between osteoporosis and sleep duration in healthy middle-aged and elderly adults: a large-scale, cross-sectional study in Japan. Sleep Breath= Schlaf Atmung 16:579–583CrossRefPubMedGoogle Scholar
  7. 7.
    Chen G, Chen L, Wen J, Yao J, Li L, Lin L, Tang K, Huang H, Liang J, Lin W, Chen H, Li M, Gong X, Peng S, Lu J, Bi Y, Ning G (2014) Associations between sleep duration, daytime nap duration, and osteoporosis vary by sex, menopause, and sleep quality. J Clin Endocrinol Metab 99:2869–2877CrossRefPubMedGoogle Scholar
  8. 8.
    Fu X, Zhao X, Lu H, Jiang F, Ma X, Zhu S (2011) Association between sleep duration and bone mineral density in Chinese women. Bone 49:1062–1066CrossRefPubMedGoogle Scholar
  9. 9.
    Moradi S, Shab-Bidar S, Alizadeh S, Djafarian K (2017) Association between sleep duration and osteoporosis risk in middle-aged and elderly women: a systematic review and meta-analysis of observational studies. Metab Clin Exp 69:199–206CrossRefPubMedGoogle Scholar
  10. 10.
    Greenland S, Longnecker MP (1992) Methods for trend estimation from summarized dose-response data, with applications to meta-analysis. Am J Epidemiol 135:1301–1309CrossRefPubMedGoogle Scholar
  11. 11.
    Hamling J, Lee P, Weitkunat R, Ambuhl M (2008) Facilitating meta-analyses by deriving relative effect and precision estimates for alternative comparisons from a set of estimates presented by exposure level or disease category. Stat Med 27:954–970CrossRefPubMedGoogle Scholar
  12. 12.
    Orsini N, Li R, Wolk A, Khudyakov P, Spiegelman D (2012) Meta-analysis for linear and nonlinear dose-response relations: examples, an evaluation of approximations, and software. Am J Epidemiol 175:66–73CrossRefPubMedGoogle Scholar
  13. 13.
    Higgins JP, Thompson SG, Deeks JJ, Altman DG (2003) Measuring inconsistency in meta-analyses. BMJ (Clin Res ed) 327:557–560CrossRefGoogle Scholar
  14. 14.
    Egger M, Davey Smith G, Schneider M, Minder C (1997) Bias in meta-analysis detected by a simple, graphical test. BMJ (Clin Res ed) 315:629–634CrossRefGoogle Scholar
  15. 15.
    Begg CB, Mazumdar M (1994) Operating characteristics of a rank correlation test for publication bias. Biometrics 50:1088–1101CrossRefPubMedGoogle Scholar
  16. 16.
    Wallace BC, Schmid CH, Lau J, Trikalinos TA (2009) Meta-Analyst: software for meta-analysis of binary, continuous and diagnostic data. BMC Med Res Methodol 9:80CrossRefPubMedPubMedCentralGoogle Scholar
  17. 17.
    Niu J, Sahni S, Liao S, Tucker KL, Dawson-Hughes B, Gao X (2015) Association between sleep duration, insomnia symptoms and bone mineral density in older Boston Puerto Rican adults. PLoS One 10:e0132342CrossRefPubMedPubMedCentralGoogle Scholar
  18. 18.
    Saint Martin M, Labeix P, Garet M, Thomas T, Barthelemy JC, Collet P, Roche F, Sforza E (2016) Does subjective sleep affect bone mineral density in older people with minimal health disorders? The PROOF cohort. J Clin Sleep Med: JCSM 12:1461–1469CrossRefPubMedGoogle Scholar
  19. 19.
    Tian Y, Shen L, Wu J, Xu G, Yang S, Song L, Zhang Y, Mandiwa C, Yang H, Liang Y, Wang Y (2015) Sleep duration and timing in relation to osteoporosis in an elderly Chinese population: a cross-sectional analysis in the Dongfeng-Tongji cohort study. Osteoporosis Int 26:2641–2648CrossRefGoogle Scholar
  20. 20.
    Wang K, Wu Y, Yang Y, Chen J, Zhang D, Hu Y, Liu Z, Xu J, Shen Q, Zhang N, Mao X, Liu C (2015) The associations of bedtime, nocturnal, and daytime sleep duration with bone mineral density in pre- and post-menopausal women. Endocrine 49:538–548CrossRefPubMedGoogle Scholar
  21. 21.
    Van Cauter E, Holmback U, Knutson K, Leproult R, Miller A, Nedeltcheva A, Pannain S, Penev P, Tasali E, Spiegel K (2007) Impact of sleep and sleep loss on neuroendocrine and metabolic function. Horm Res 67(Suppl 1):2–9PubMedGoogle Scholar
  22. 22.
    Leproult R, Van Cauter E (2010) Role of sleep and sleep loss in hormonal release and metabolism. Endocr Dev 17:11–21CrossRefPubMedGoogle Scholar
  23. 23.
    Specker BL, Binkley T, Vukovich M, Beare T (2007) Volumetric bone mineral density and bone size in sleep-deprived individuals. Osteoporosis Int 18:93–99CrossRefGoogle Scholar
  24. 24.
    Cummings SR, Browner WS, Bauer D, Stone K, Ensrud K, Jamal S, Ettinger B (1998) Endogenous hormones and the risk of hip and vertebral fractures among older women. Study of osteoporotic fractures research group. N Engl J Med 339:733–738CrossRefPubMedGoogle Scholar
  25. 25.
    Slemenda CW, Longcope C, Zhou L, Hui SL, Peacock M, Johnston CC (1997) Sex steroids and bone mass in older men. Positive associations with serum estrogens and negative associations with androgens. J Clin Invest 100:1755–1759CrossRefPubMedPubMedCentralGoogle Scholar
  26. 26.
    Everson CA, Folley AE, Toth JM (2012) Chronically inadequate sleep results in abnormal bone formation and abnormal bone marrow in rats. Exp Biol Med (Maywood, NJ) 237:1101–1109CrossRefGoogle Scholar
  27. 27.
    Pyykkonen AJ, Isomaa B, Pesonen AK, Eriksson JG, Groop L, Tuomi T, Raikkonen K (2014) Sleep duration and insulin resistance in individuals without type 2 diabetes: the PPP-Botnia study. Ann Med 46:324–329CrossRefPubMedGoogle Scholar
  28. 28.
    Javaheri S, Storfer-Isser A, Rosen CL, Redline S (2011) Association of short and long sleep durations with insulin sensitivity in adolescents. J Pediatr 158:617–623CrossRefPubMedGoogle Scholar
  29. 29.
    Xia J, Zhong Y, Huang G, Chen Y, Shi H, Zhang Z (2012) The relationship between insulin resistance and osteoporosis in elderly male type 2 diabetes mellitus and diabetic nephropathy. Ann Endocrinol 73:546–551CrossRefGoogle Scholar
  30. 30.
    Cizza G, Primma S, Csako G (2009) Depression as a risk factor for osteoporosis. Trends Endocrinol Metab 20:367–373CrossRefPubMedPubMedCentralGoogle Scholar
  31. 31.
    Howe TE, Shea B, Dawson LJ, Downie F, Murray A, Ross C, Harbour RT, Caldwell LM, Creed G (2011) Exercise for preventing and treating osteoporosis in postmenopausal women. The Cochrane database of systematic reviews CD000333Google Scholar
  32. 32.
    Shea B, Bonaiuti D, Iovine R, Negrini S, Robinson V, Kemper HC, Wells G, Tugwell P, Cranney A (2004) Cochrane review on exercise for preventing and treating osteoporosis in postmenopausal women. Europa Medicophysica 40:199–209PubMedGoogle Scholar
  33. 33.
    Kinoshita Y, Fukumoto S (2012) Space flight/bedrest immobilization and bone. Medical treatment for immobilization osteoporosis. Clin Calcium 22:1895–1901PubMedGoogle Scholar
  34. 34.
    Schott N, Korbus H (2014) Preventing functional loss during immobilization after osteoporotic wrist fractures in elderly patients: a randomized clinical trial. BMC Musculoskelet Disord 15:287CrossRefPubMedPubMedCentralGoogle Scholar
  35. 35.
    Tanaka S, Yoshimura N, Kuroda T, Hosoi T, Saito M, Shiraki M (2010) The fracture and immobilization score (FRISC) for risk assessment of osteoporotic fracture and immobilization in postmenopausal women—a joint analysis of the Nagano, Miyama, and Taiji cohorts. Bone 47:1064–1070CrossRefPubMedGoogle Scholar
  36. 36.
    Pakarinen TK, Laine HJ, Maenpaa H, Kahonen M, Mattila P, Lahtela J (2013) Effect of immobilization, off-loading and zoledronic acid on bone mineral density in patients with acute Charcot neuroarthropathy: a prospective randomized trial. Foot Ankle Surg 19:121–124CrossRefPubMedGoogle Scholar
  37. 37.
    Norimatsu H, Mori S, Kawanishi J, Kaji Y, Li J (1997) Immobilization as the pathogenesis of osteoporosis: experimental and clinical studies. Osteoporosis Int 7(Suppl 3):S57–S62CrossRefGoogle Scholar
  38. 38.
    Girschik J, Fritschi L, Heyworth J, Waters F (2012) Validation of self-reported sleep against actigraphy. J Epidemiol 22:462–468CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© International Osteoporosis Foundation and National Osteoporosis Foundation 2018

Authors and Affiliations

  1. 1.Department of Occupational & Environmental Health, School of Public Health, Tongji Medical CollegeHuazhong University of Science and TechnologyWuhanChina
  2. 2.Wuhan Prevention and Treatment Center for Occupational DiseasesWuhanPeople’s Republic of China
  3. 3.Department of Clinical MedicineXi’an Medical UniversityXi’anPeople’s Republic of China
  4. 4.Department of EmergencyWuhan Center for Diseases Prevention and ControlWuhanPeople’s Republic of China
  5. 5.Department of Social Medicine and Health Management, School of Public Health, Tongji Medical CollegeHuazhong University of Science and TechnologyWuhanPeople’s Republic of China

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