# Sleep trajectories and osteoporosis incidence: findings from two prospective cohort studies

## TL;DR

Long-term poor sleep quality is linked to a higher risk of osteoporosis in older adults, according to two large studies.

## Contribution

This study is novel in using repeated sleep quality measurements to assess their longitudinal relationship with osteoporosis risk.

## Key findings

- Poor sleep quality at baseline was associated with higher osteoporosis prevalence in both ELSA and HRS cohorts.
- Persistent poor sleep quality over time significantly increased the risk of developing osteoporosis.
- Improving sleep quality may help prevent bone loss, suggesting sleep-focused interventions could reduce osteoporosis risk.

## Abstract

Most studies evaluate sleep quality at a single time point, and few have employed repeated measurements to investigate this association. This longitudinal research investigated changes in sleep quality patterns among older adults and examined their relationship with the onset of osteoporosis.

We analyzed data from two prospective cohorts: Participants comprised 4,328 individuals from the English Longitudinal Study of Aging (ELSA) and 9,132 from the U.S. Health and Retirement Study (HRS). Sleep quality was quantified using standardized sleep quality scores, and trajectories were determined based on baseline and follow-up assessments. Changes in sleep quality status were categorized to reflect persistent, improving, or deteriorating patterns. Associations between sleep quality trajectories and osteoporosis incidence were examined using Cox proportional hazards regression models.

At baseline, sleep quality was significantly associated with the prevalence of osteoporosis in both datasets (ELSA: HR = 1.11, 95% CI: 1.08–1.15; HRS: HR = 1.1, 95% CI: 1.07–1.13). During the follow-up period, compared with participants with persistently good sleep quality, those with persistently poor sleep quality had a significantly increased risk of osteoporosis (ELSA: HR = 1.89, 95% CI: 1.47–2.44; HRS: HR = 1.52, 95% CI: 1.26–1.82).

Poor sleep trajectories significantly increase osteoporosis risk, suggesting sleep improvement may help prevent bone loss. These consistent findings across two cohorts support sleep-focused interventions as a potential osteoporosis prevention strategy.