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Short Sleep Is Associated With Low Bone Mineral Density and Osteoporosis in the Women's Health Initiative.

  • Ochs-Balcom, Heather M1
  • Hovey, Kathleen M1
  • Andrews, Christopher2
  • Cauley, Jane A3
  • Hale, Lauren4
  • Li, Wenjun5
  • Bea, Jennifer W6
  • Sarto, Gloria E7
  • Stefanick, Marcia L8
  • Stone, Katie L9, 10
  • Watts, Nelson B11
  • Zaslavsky, Oleg12
  • Wactawski-Wende, Jean1
  • 1 Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, University at Buffalo, The State University of New York, Buffalo, NY, USA.
  • 2 Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, MI, USA.
  • 3 Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA.
  • 4 Program in Public Health, Department of Family, Population and Preventive Medicine, Stony Brook University, Stony Brook, NY, USA.
  • 5 Department of Medicine, University of Massachusetts Medical School, Worcester, MA, USA.
  • 6 Department of Medicine, University of Arizona Cancer Center, Tucson, AZ, USA.
  • 7 Department of Obstetrics and Gynecology, School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA.
  • 8 Stanford Prevention Research Center, Stanford University School of Medicine, Palo Alto, CA, USA.
  • 9 Research Institute, California Pacific Medical Center, San Francisco, CA, USA.
  • 10 Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA.
  • 11 Mercy Health Osteoporosis and Bone Health Services, Cincinnati, OH, USA.
  • 12 Department of Biobehavioral Nursing and Health Informatics, University of Washington School of Nursing, Seattle, WA, USA.
Published Article
Journal of Bone and Mineral Research
Wiley (John Wiley & Sons)
Publication Date
Nov 06, 2019
DOI: 10.1002/jbmr.3879
PMID: 31692127


Short sleep duration, recognized as a public health epidemic, is associated with adverse health conditions, yet little is known about the association between sleep and bone health. We tested the associations of usual sleep behavior and bone mineral density (BMD) and osteoporosis. In a sample of 11,084 postmenopausal women from the Women's Health Initiative (WHI; mean age 63.3 years, SD = 7.4), we performed a cross-sectional study of the association of self-reported usual hours of sleep and sleep quality (WHI Insomnia Rating Score) with whole body, total hip, femoral neck, and spine BMD using linear regression models. We also studied the association of sleep duration and quality with dual-energy X-ray absorptiometry (DXA)-defined low bone mass (T-score < -2.5 to <-1) and osteoporosis (T-score ≤ -2.5) using multinomial regression models. We adjusted for age, DXA machine, race, menopausal symptoms, education, smoking, physical activity, body mass index, alcohol use, physical function, and sleep medication use. In adjusted linear regression models, women who reported sleeping 5 hours or less per night had on average 0.012 to 0.018 g/cm2 significantly lower BMD at all four sites compared with women who reported sleeping 7 hours per night (reference). In adjusted multinomial models, women reporting 5 hours or less per night had higher odds of low bone mass and osteoporosis of the hip (odds ratio [OR] = 1.22; 95% confidence interval [CI] 1.03-1.45, and 1.63; 1.15-2.31, respectively). We observed a similar pattern for spine BMD, where women with 5 hours or less per night had higher odds of osteoporosis (adjusted OR = 1.28; 95% CI 1.02-1.60). Associations of sleep quality and DXA BMD failed to reach statistical significance. Short sleep duration was associated with lower BMD and higher risk of osteoporosis. Longitudinal studies are needed to confirm the cross-sectional effects of sleep duration on bone health and explore associated mechanisms. © 2019 American Society for Bone and Mineral Research. © 2019 American Society for Bone and Mineral Research.

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