Association between obstructive sleep apnea and low bone mass in adults: a systematic review and meta-analysis

Introduction This study aimed to synthesize existing evidence on the potential association between obstructive sleep apnea (OSA) and low bone mass in adults. Methods Electronic searches of four main databases were performed. The inclusion criteria consisted of observational studies investigating the relationship between OSA and bone mass, osteoporosis, fractures, or bone metabolism markers in adult population. Bone mineral density (BMD) and T score of lumbar and femur neck, incidence of osteoporosis and fractures, bone metabolism marker levels were extracted as primary outcomes. Results Among the 693 relevant publications, 10 studies consisting of 158,427 participants met with the inclusion and exclusion criteria. Meta-analysis showed a significant lower BMD of lumbar (mean difference (MD) = − 0.03; 95% CI − 0.05, − 0.01; I 2 = 46%), femur neck (MD = − 0.06; 95% CI − 0.12, 0.00; I 2 = 71%), and a significant lower T score of lumbar (MD = − 0.42; 95% CI − 0.79, − 0.05; I 2 = 63%) in the OSA group. The results suggested that both male (odds ratio (OR) = 2.03; 95% CI 1.23, 3.35; I 2 = 38%) and female (OR = 2.56; 95% CI 1.96, 3.34; I 2 = 0%) had higher risk of osteoporosis in the OSA group. Besides, meta-analysis also showed that bone-specific alkaline phosphatase was significantly lower in OSA patients (MD = − 1.90; 95% CI − 3.48, − 0.32; I 2 = 48%). Conclusions A potential association between OSA and lower bone mass in adults is preliminarily proved. It also seems plausible that both male and female with OSA have a higher risk of osteoporosis.