Sleep Duration and Social Determinants of Health Predict Osteoporosis in Adults 50 Years of Age and Older After Controlling for Vitamin D, Demographic Characteristics, and Physical Activity.




Campbell, Blake
Fulda, Kimberly
Zhang, Fan
Webb, Brian
Espinoza, Anna
Navid, Daniel


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Osteoporosis is a bone disease that develops when bone density and mass decreases, or when the quality or structure of bone changes. There are many causes of osteoporosis, with some etiologies being more understood than others. Prevention is critical in the treatment of osteoporosis, due to its serious complications, including life altering hip and spine fractures. Despite prevention and treatment, osteoporosis in most cases is inevitable, but the onset and severity is what can be helped. Finding other ways to slow or even prevent osteoporosis is an active area of study, with sleep being one of the many variables of interest due to its role in homeostasis. The literature demonstrates contradictory findings for the relationship between sleep and osteoporosis. Many of the studies lack a recent and/or big enough sample size, and there is a need for further research on the subject. Additionally, recent literature has not included variables representative of social determinants of health, such as income and education. The purpose of this study was to further investigate the association that between sleep and osteoporosis in individuals 50 and older using the NHANES Database while controlling for potential covariates such as social determinants of health.


Data from the National Health and Nutrition Examination Survey (NHANES), 2017-2020 were analyzed to determine the association between sleep duration and osteoporosis in adults 50 and older. Multivariate logistic regression was performed controlling for race/ethnicity, age (≥50 years), gender, highest household education, physical activity, poverty, vitamin D, and BMI. Analyses were considered statistically significant at p<0.05.


Analyses included 4963 adults over the age of 50, with 51% (2507) being female. A total of 12.3% (611) of the cohort had a diagnosis of osteoporosis, with 87% of the osteoporotic group being female (530). Mean age was 65.2 years (sd=9.3) for the total sample, 64.5 (sd=9.2) for non-osteoporotic individuals, and 70.0 (sd=8.8) for osteoporotic individuals. In the adjusted analyses, we found no statistically significant association between sleep duration and osteoporosis. There is a statistically significant association between family monthly poverty level and osteoporosis ([OR:0.93; 95%CI(0.87-0.99) p=0.047]. BMI, Age, and Gender were also significantly associated with osteoporosis. Other social determinants of health such as race, physical activity, and education were not statistically significant. Vitamin D was also not associated with osteoporosis.


The purpose of this study was to further investigate the association between sleep and osteoporosis in individuals 50 and older while controlling for covariates, particularly social determinants of health. We looked at specifically sleep duration, and a previous diagnosis of osteoporosis. We theorized that lower sleep durations may have an association with osteoporosis; however, our results did not support this. The association between family poverty index and osteoporosis highlights the importance of exploring socioeconomic differences in sleep and osteoporosis research in the future, respectively. Finally, this study is limited by a lack of a quantitative measure of osteoporosis. Future work with additional socioeconomic variables and more consistent data collecting modalities should shed more light on the subject