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Association between objective sleep duration and bone mineral density in older postmenopausal women from the Study of Osteoporotic Fractures (SOF)

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Abstract

Summary

Methodological limitations preclude determination of the association between sleep duration and bone mineral density (BMD) from existing literature. This was the first study to use objective sleep duration to determine its association with BMD. Nocturnal sleep duration, assessed objectively (actigraphy) or subjectively (questionnaire), was not independently associated with BMD in postmenopausal women.

Introduction

Both long and short self-reported sleep durations are associated with low bone mineral density (BMD) in men and women. The association between sleep duration measured by actigraphy and BMD in postmenopausal women is unknown.

Methods

The Study of Osteoporotic Fractures (SOF) ancillary sleep study was used to determine the association between sleep duration and BMD at the total hip and femoral neck in postmenopausal women ≥ 75 years old. Sleep duration was assessed by wrist actigraphy (average 4 nights) and questionnaire. BMD was compared between postmenopausal women with short (< 6 h/night) vs. NIH-recommended (7–8 h/night) sleep durations. Data were analyzed using a 2-sample t test (unadjusted) and multivariate regression model (adjusted). Simple linear regression was used to estimate the difference in BMD per additional hour of sleep when sleep duration was considered as a continuous, rather than dichotomized, variable.

Results

Total hip BMD was higher in women with actigraphically assessed shorter sleep duration in unadjusted models only. No clinically or statistically significant differences in total hip or femoral neck BMD were observed according to nocturnal sleep duration after adjusting for body mass index (BMI) in dichotomized (N = 874) or continuous (N = 1624) sleep duration models or when subjective sleep duration was used. When sleep duration included daytime naps, longer sleep duration was associated with lower total hip BMD (β = − 0.005, p = 0.04).

Conclusions

Nocturnal sleep duration, whether assessed objectively (actigraphy) or subjectively (questionnaire), was not independently associated with BMD in older postmenopausal women.

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Abbreviations

BMD:

Bone mineral density

P1NP:

Propeptide of type 1 procollagen N-terminal

CTX:

C-telopeptide of type I collagen

AASM:

American Academy of Sleep Medicine

SRS:

Sleep Research Society

SOF:

Study of Osteoporotic Fractures

QUS:

Quantitative ultrasound

DXA:

Dual-energy X-ray absorptiometry

BMI:

Body mass index

PIM:

Proportional integration mode

h:

hour

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Acknowledgments

The authors thank Lily Lui for her assistance with this analysis. In addition, the authors thank the Investigators in the Study of Osteoporotic Fractures Research Group: San Francisco Coordinating Center (California Pacific Medical Center Research Institute and University of California San Francisco): SR Cummings (co-principal investigator), K Yaffe (co-principal investigator), DC Bauer (co-investigator), DM Black (co-investigator), PM Cawthon (co-investigator), N Lane (co-investigator), C McCulloch (co-investigator), A Schwartz (co-investigator), G Tranah (co-investigator), D Evans (co-investigator), R Benard, T Blackwell, L Concepcion, S Ewing, SL Harrison, D Kriesel, N Parimi, K Peters, C Schambach, and J Ziarno.

Funding

CMS is supported by NIH grant T32DK007674-20, NIH grant T32DK007446-34, and 1K23AR070275-01.

The Study of Osteoporotic Fractures (SOF) is supported by the National Institutes of Health funding. The National Institute on Aging (NIA) provides support under the following grant numbers: R01 AG005407, R01 AR35582, R01 AR35583, R01 AR35584, R01 AG005394, R01 AG027574, R01 AG027576, and R01 AG026720.

The research reported in this publication was supported by the National Institute of Arthritis and Musculoskeletal and Skin Diseases of the National Institutes of Health under Award Number 1K23AR070275-01, P50 HD073063 (Kohrt), and the Eastern Colorado VA Geriatric, Research, Education, and Clinical Center (GRECC). The contents do not represent the views of the U.S. Department of Veterans Affairs or the United States Government. This research is also supported by NIH/NCATS Colorado CTSA Grant Number UL1 TR002535. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Author information

Author notes

  1. Drs. Kohrt and Stone are co-senior authors. They both contributed equally to this work.

Authors and Affiliations

  1. Division of Endocrinology, Metabolism and Diabetes, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, 80045, USA

    C.M. Swanson, K.P. Wright Jr & M.E. Wierman

  2. Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado, Aurora, CO, USA

    P.J. Blatchford

  3. Division of Endocrinology and Bone & Mineral Unit, Oregon Health & Science University, Portland, OR, USA

    E.S. Orwoll

  4. Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA

    J.A. Cauley

  5. Kaiser Permanente Center for Health Research NW, Portland, OR, USA

    E.S. LeBlanc

  6. Geriatric Research Education and Clinical Center, Minneapolis Veterans Affairs Health Care System, Minneapolis, MN, USA

    H.A. Fink

  7. Department of Integrative Physiology, University of Colorado Boulder, Boulder, CO, USA

    K.P. Wright Jr

  8. Research Service, Rocky Mountain Regional Veterans Affairs Medical Center Aurora, Aurora, CO, USA

    M.E. Wierman

  9. Division of Geriatric Medicine, and Eastern Colorado VA Geriatric, Research, Education, and Clinical Center (GRECC), University of Colorado Anschutz Medical Campus, Aurora, CO, USA

    W.M. Kohrt

  10. Research Institute, California Pacific Medical Center, San Francisco, CA, USA

    K.L. Stone

  11. San Francisco Coordinating Center, University of California San Francisco, San Francisco, CA, USA

    K.L. Stone

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for the Study of Osteoporotic Fractures (SOF)

Corresponding author

Correspondence to C.M. Swanson.

Ethics declarations

The Institutional Review Board at each SOF clinical site approved the study, and all participants provided written consent.

Conflict of interest

In the interest of full disclosure, we report the following; however, we do not believe any of these pertain to the current work. PJB, JAC, HAF, MEW, WMK have nothing to disclose. CMS did consulting for Radius Health, Inc. ESL was PI on an unrelated Merck, Inc. grant given to her institution. This funding does not reflect a conflict of interest. KPW reports research support from the NIH, Office of Naval Research, Pac-12, Philips Inc., CurAegis Technologies (formerly known as Torvec Inc.), Somalogics; Financial relationships: consulting fees from or served as a paid member of scientific advisory boards for NIH (Sleep Disorders Research Advisory Board - National Heart, Lung and Blood Institute), CurAegis Technologies, Circadian Therapeutics, LTD, Kellogg Company; Board of Directors: Sleep Research Society; Speaker/educational consultant honorarium fees: American Academy of Sleep Medicine, American College of Chest Physicians, American Diabetes Association. ESO consults for and has received research support from Radius, Mereo, and Bayer. ESO, for The Osteoporotic Fractures in Men (MrOS) Study, is supported by the National Institutes of Health funding via the following institutes: the National Institute on Aging (NIA), the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), the National Center for Advancing Translational Sciences (NCATS), and NIH Roadmap for Medical Research, under the following grant numbers: U01AG027810, U01 AG042124, U01 AG042139, U01 AG042140,U01 AG042143, U01 AG042145, U01 AG042168, U01AR066160, and UL1 TR000128. KLS has received grant funding from Merck.

Ethical approval

The current analysis utilized de-identified data and was deemed non-human subjects research by the Colorado Multiple Institutional Review Board.

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Swanson, C., Blatchford, P., Orwoll, E. et al. Association between objective sleep duration and bone mineral density in older postmenopausal women from the Study of Osteoporotic Fractures (SOF). Osteoporos Int 30, 2087–2098 (2019). https://doi.org/10.1007/s00198-019-05007-5

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