Bone Mineral Density in Obstructive Sleep Apnea and Obesity
Authors: Sompalli Sreeja , Singh Prachi , Naumann Dominik , Covassin Naima , Somers Virend K. 
Published: June 2021

Background

Osteoporosis, a condition associated with decreased bone density, contributes significantly to morbidity and mortality. Importantly, the incidence and economic burden of osteoporosis is rising partly due to increases in the aging population. Moreover, while the role of obesity on bone health is controversial, studies suggest that obesity alters bone density. Effects of obstructive sleep apnea (OSA), which is more prevalent in ageing and obesity, on any relationship between obesity and BMD are not well known.

Objective

To examine the effects of BMI and OSA on total and regional bone density.

Methods

A database of all research participants with nocturnal polysomnography and whole body dual energy X‐Ray absorptiometry scan (DEXA) was created. The study population included 72 subjects without OSA (AHI<5, Age: 29.1 ± 7.3 years, BMI: 24.3 ± 3.6 Kg/m2) and 22 subjects with OSA (apnea hypopnea index, AHI>5; 4 females, Age: 43.3 ± 11.2 years, BMI: 30.8 ± 4.1 Kg/m2). We examined the relationship between BMI and BMD in all our subjects. Linear regression models adjusted for age and BMI were used to assess changes in bone density in the presence of OSA. Additional analyses examining the effects of OSA in overweight and obese individuals (BMI>25 kg/m2) and relationship between BMI and BMD in OSA subjects were also undertaken.

Results

Total body bone density in all our study subjects was positively correlated with BMI (Std Beta = 0.42, 95% CI 0.004 – 0.015, p < 0.001) but not age (Std Beta = 0.04, 95% CI −0.002 −0.003, p = 0.71) or presence of OSA (Std Beta = 0.042, −0.029 − 0.040, p = 0.75). Similarly, bone density in spine was increased with increases in BMI (Std Beta = 0.45, 95% CI 0.006 − 0.019, p = 0.0003) and not affected by age (Std Beta = 0.14, 95% CI −0.001 – 0.005, p = 0.23) or presence of OSA (Std Beta = 0.18, 95% CI −0.011 – 0.065, p = 0.16). Also, increases in BMD in pelvic region were only associated with BMI (Std Beta = 0.30, 0.001 – 0.019, p = 0.024). Age (Std Beta = −0.09, −0.005 – 0.002, p = 0.45) or presence of OSA (Std Beta = 0.19, −0.016 – 0.086, p = 0.17) did not alter BMD in pelvic area. Interestingly, overweight and obese subjects with OSA had a lower pelvic BMD compared to overweight and obese subjects without OSA (1.10 ± 0.12 g/cm3 Vs. 1.19 ± 0.16 g/cm3, p = 0.043), even when OSA subjects had a higher BMI (31.4± 3.7 kg/m2 Vs. 27.8± 3.2 Kg/m2, p = 0.001) and were older (43.4 ± 11.3 years Vs 30.6 ± 8.8 years, p<0.001). Also, the positive relationship between BMI and BMD was not present in OSA subjects in our study population (Total BMD: p = 0.73; Spine BMD: p = 0.94; Pelvic BMD: p=0.77).

Conclusion

A positive association between bone density and BMI was observed in our study population. However, this relationship was not evident in OSA subjects. Further, our study suggests that OSA may be accompanied by decreased bone density in the pelvic region. Cross‐sectional and longitudinal studies examining the effects of OSA on regional bone density, fractures, and frailty in BMI, age and gender matched populations are warranted.

Support or Funding Information

VKS and PS are supported by NIH grant HL65176

This abstract is from the Experimental Biology 2019 Meeting. There is no full text article associated with this abstract published in The FASEB Journal.