Expert consensus on osteoporosis risk management in patients with sleep disorders

Siqi Leng , Jinming Yang , Yuming Jin , Jie Shi , Ye Zhang , Junying Zhou , Lu Tan , Taomei Li , Peiyan Ni , Kejia Hu , Yuan Shi , Jiamin Liao , Yun Li , Pei Xue , Christian Benedict , Alexandros N. Vgontzas , Michael Furian , Talant Sooronbaev , Naima Covassin , Virend K. Somers , Zhoulong Yu , Hongqiang Sun , Xiao Tan , Jihui Zhang , Yun Kwok Wing , Yue Leng , Larry D. Sanford , Michael V. Vitiello , Katie L. Stone , Rong Ren , Lin Lu , Xiangdong Tang

Bone Research ›› 2026, Vol. 14 ›› Issue (1) : 85

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Bone Research ›› 2026, Vol. 14 ›› Issue (1) :85 DOI: 10.1038/s41413-026-00562-0
Consensus Statement
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Expert consensus on osteoporosis risk management in patients with sleep disorders
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Abstract

A rate-limiting step in the prevention and early intervention of osteoporosis is identifying its asymptomatic onset. Accumulating evidence shows that sleep disorders are associated with an increased risk of osteoporosis. Given their early detectable and modifiable nature, integrating sleep disorder management into osteoporosis prevention and care pathways offers a novel approach for enhancing skeletal health. This expert consensus represents a collaborative effort by specialists in sleep medicine and orthopedics from across the world, integrating epidemiological, mechanistic, and interventional evidence to provide general guidance for prevention and clinical practice, and to foster multidisciplinary collaboration in the management of sleep disorders and osteoporosis.

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Siqi Leng, Jinming Yang, Yuming Jin, Jie Shi, Ye Zhang, Junying Zhou, Lu Tan, Taomei Li, Peiyan Ni, Kejia Hu, Yuan Shi, Jiamin Liao, Yun Li, Pei Xue, Christian Benedict, Alexandros N. Vgontzas, Michael Furian, Talant Sooronbaev, Naima Covassin, Virend K. Somers, Zhoulong Yu, Hongqiang Sun, Xiao Tan, Jihui Zhang, Yun Kwok Wing, Yue Leng, Larry D. Sanford, Michael V. Vitiello, Katie L. Stone, Rong Ren, Lin Lu, Xiangdong Tang. Expert consensus on osteoporosis risk management in patients with sleep disorders. Bone Research, 2026, 14 (1) : 85 DOI:10.1038/s41413-026-00562-0

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References

[1]

Consensus Development Conference Panel. Consensus development conference: Diagnosis, prophylaxis, and treatment of osteoporosis. Am. J. Med.94, 646–650 (1993).

[2]

Huo S, et al.. Epigenetic regulations of cellular senescence in osteoporosis. Ageing Res. Rev., 2024, 99 ArticleID: 102235

[3]

Xiao PL, et al.. Global, regional prevalence, and risk factors of osteoporosis according to the World Health Organization diagnostic criteria: a systematic review and meta-analysis. Osteoporos. Int., 2022, 33: 2137-2153

[4]

Clynes MA, et al.. The epidemiology of osteoporosis. Br. Med. Bull., 2020, 133: 105-117

[5]

Panahi, N. et al. Trend in global burden attributable to low bone mineral density in different WHO regions: 2000 and beyond, results from the Global Burden of Disease (GBD) study 2019. Endocr Connect. 12, e230160 (2023).

[6]

Sànchez-Riera L, et al.. The global burden attributable to low bone mineral density. Ann. Rheum. Dis., 2014, 73: 1635-1645

[7]

Irwin MR. Why sleep is important for health: a psychoneuroimmunology perspective. Annu. Rev. Psychol., 2015, 66: 143-172

[8]

Gauld C, Wakefield JC, Micoulaud-Franchi JA. Proposing a definition for sleep disorders: An epistemological review. Sleep. Med. Rev., 2025, 79 ArticleID: 102028

[9]

Buysse DJ. Insomnia. JAMA, 2013, 309: 706-716

[10]

Sun SY, Chen GH. Treatment of circadian rhythm sleep-wake disorders. Curr. Neuropharmacol., 2022, 20: 1022-1034

[11]

Meyer N, Harvey AG, Lockley SW, Dijk DJ. Circadian rhythms and disorders of the timing of sleep. Lancet, 2022, 400: 1061-1078 4

[12]

Senaratna CV, et al.. Prevalence of obstructive sleep apnea in the general population: A systematic review. Sleep. Med. Rev., 2017, 34: 70-81

[13]

Korostovtseva L, Bochkarev M, Sviryaev Y. Sleep and cardiovascular Risk. Sleep. Med. Clin., 2021, 16: 485-497

[14]

Koren D, Taveras EM. Association of sleep disturbances with obesity, insulin resistance and the metabolic syndrome. Metabolism, 2018, 84: 67-75

[15]

Gottesman RF, et al.. Impact of sleep disorders and disturbed sleep on brain health: a scientific statement from the American Heart Association. Stroke, 2024, 55: e61-e76

[16]

Sivertsen B, et al.. Insomnia as a risk factor for ill health: results from the large population-based prospective HUNT Study in Norway. J. Sleep. Res., 2014, 23: 124-132

[17]

Chan YH, Teo CB, Tay JK, Cheong CS. The association between obstructive sleep apnea and osteoporosis: A systematic review and meta-analysis. Sleep. Med. Rev., 2024, 78 ArticleID: 102006

[18]

Swanson CM, et al.. The importance of the circadian system & sleep for bone health. Metabolism, 2018, 84: 28-43

[19]

Depner CM, Stothard ER, Wright KPJr. Metabolic consequences of sleep and circadian disorders. Curr. Diab. Rep., 2014, 14: 507

[20]

Sivertsen B, et al.. Insomnia as a risk factor for ill health: results from the large population-based prospective HUNT Study in Norway. J. Sleep. Res., 2014, 23: 124EP-124132

[21]

Yen CM, et al.. Sleep disorders increase the risk of osteoporosis: a nationwide population-based cohort study. Sleep Med., 2014, 15: 1339-1344

[22]

Cherian KE, Kapoor N, Paul TV. Disrupted sleep architecture is associated with incident bone loss in indian postmenopausal women: a prospective study. J. Bone Miner. Res., 2022, 37: 1956-1962

[23]

Supa P, Peltzer K, Dararatt A. Longitudinal health consequences of insomnia symptoms among middle-aged and older adults in Thailand. Elder. Health J., 2024, 10: 7-13

[24]

Rassow K, et al.. Sleep characteristics and parameters of bone turnover and strength in the adult population: results from the Study of Health in Pomerania-TREND. J. Sleep Res., 2024, 33 ArticleID: e14019

[25]

Zhao H, et al.. Associations of sleep behaviors and genetic risk with risk of incident osteoporosis: A prospective cohort study of 293,164 participants. Bone, 2024, 186 ArticleID: 117168

[26]

Zhou T, et al.. Adherence to a healthy sleep pattern is associated with lower risks of incident falls and fractures during aging. Front. Immunol., 2023, 14 ArticleID: 1234102

[27]

Niu J, et al.. Association between sleep duration, insomnia symptoms and bone mineral density in older Boston Puerto Rican adults. PLoS One, 2015, 10: e0132342

[28]

Yamaura R, Kasahara H, Iimuro S, Yamazaki T. The association between sleep and bone mineral density: cross-sectional study using health check-up data in a local hospital in Japan. JBMR, 2023, 7e10820

[29]

Pan F, Tian J, Cicuttini F, Jones G. Sleep disturbance and bone mineral density, risk of falls and fracture: Results from a 10.7-year prospective cohort study. Bone, 2021, 147 ArticleID: 115938

[30]

Riemann D, et al.. The hyperarousal model of insomnia: a review of the concept and its evidence. Sleep. Med. Rev., 2010, 14: 19-31

[31]

Vgontzas AN, et al.. Chronic insomnia and activity of the stress system: a preliminary study. J. Psychosom. Res., 1998, 45: 21-31

[32]

Vgontzas AN, Chrousos GP. Sleep, the hypothalamic-pituitary-adrenal axis, and cytokines: multiple interactions and disturbances in sleep disorders. Endocrinol. Metab. Clin. North Am., 2002, 31: 15-36

[33]

Hardy RS, Zhou H, Seibel MJ, Cooper MS. Glucocorticoids and bone: consequences of endogenous and exogenous excess and replacement therapy. Endocr. Rev., 2018, 39: 519-548

[34]

Bonnet MH, Arand DL. Hyperarousal and insomnia: state of the science. Sleep. Med. Rev., 2010, 14: 9-15

[35]

Elefteriou F. Impact of the autonomic nervous system on the skeleton. Physiol. Rev., 2018, 98: 1083-1112

[36]

Van Cauter E, Spiegel K, Tasali E, Leproult R. Metabolic consequences of sleep and sleep loss. Sleep. Med., 2008, 9: S23-S28

[37]

Giustina A, Mazziotti G, Canalis E. Growth hormone, insulin-like growth factors, and the skeleton. Endocr. Rev., 2008, 29: 535-559

[38]

Muehlan C, Roch C, Vaillant C, Dingemanse J. The orexin story and orexin receptor antagonists for the treatment of insomnia. J. Sleep. Res., 2023, 32 ArticleID: e13902

[39]

Wei W, et al.. Orexin regulates bone remodeling via a dominant positive central action and a subordinate negative peripheral action. Cell Metab., 2014, 19: 927-940

[40]

Mong JA, Cusmano DM. Sex differences in sleep: impact of biological sex and sex steroids. Philos. Trans. R. Soc. Lond. B Biol. Sci., 2016, 371: 20150110

[41]

Vgontzas AN, et al.. Chronic insomnia is associated with a shift of interleukin-6 and tumor necrosis factor secretion from nighttime to daytime. Metabolism, 2002, 51: 887-892

[42]

Fernandez-Mendoza J, et al.. Insomnia symptoms with objective short sleep duration are associated with systemic inflammation in adolescents. Brain Behav. Immun., 2017, 61: 110-116

[43]

Adamopoulos IE. Inflammation in bone physiology and pathology. Curr. Opin. Rheumatol., 2018, 30: 59-64

[44]

Iantomasi, T. et al. Oxidative Stress and Inflammation in Osteoporosis: Molecular Mechanisms Involved and the Relationship with microRNAs. Int. J. Mol. Sci. 24, 3772 (2023).

[45]

Wu, Q., Gao, G., Kwok, L. Y., Lv H. & Sun, Z. Insomnia: the gut microbiome connection, prospects for probiotic and postbiotic therapies, and future directions. J. Adv. Res. 82, 267–293 (2026).

[46]

He Y, Chen Y. The potential mechanism of the microbiota-gut-bone axis in osteoporosis: a review. Osteoporos. Int., 2022, 33: 2495-2506

[47]

Qi X, Kong H, Li J, Chen C. The relationship between insomnia and multidimensional frailty in community-dwelling older adults: A systematic review. Arch. Gerontol. Geriatr., 2025, 129 ArticleID: 105661

[48]

Nemoto Y, et al.. Bidirectional relationship between insomnia and frailty in older adults: A 2-year longitudinal study. Arch. Gerontol. Geriatr., 2021, 97 ArticleID: 104519

[49]

Gielen E, Dupont J, Dejaeger M, Laurent MR. Sarcopenia, osteoporosis and frailty. Metabolism, 2023, 145 ArticleID: 155638

[50]

Javaheri S, Redline S. Insomnia and risk of cardiovascular disease. Chest, 2017, 152: 435-444

[51]

Sharafi MH, Nazari A, Cheraghi M, Souri F, Bakhshesh M. The link between osteoporosis and cardiovascular diseases: a review of shared mechanisms, risk factors, and therapeutic approaches. Osteoporos. Int., 2025, 36: 1129-1142

[52]

Wong, S. K., Chin, K. Y., Suhaimi, F. H., Ahmad, F., Ima-Nirwana, S. The relationship between metabolic syndrome and osteoporosis: a review. Nutrients8, 347 (2016).

[53]

Konjarski M, Murray G, Lee VV, Jackson ML. Reciprocal relationships between daily sleep and mood: a systematic review of naturalistic prospective studies. Sleep. Med Rev., 2018, 42: 47-58

[54]

Mezuk B, Eaton WW, Golden SH. Depression and osteoporosis: epidemiology and potential mediating pathways. Osteoporos. Int., 2008, 19: 1-12

[55]

Seppala LJ, et al.. Fall-risk-increasing drugs: a systematic review and meta-analysis: II. Psychotropics. J. Am. Med. Dir. Assoc., 2018, 19: 371 e11-371 e17

[56]

Xing D, et al.. Association between use of benzodiazepines and risk of fractures: a meta-analysis. Osteoporos. Int., 2014, 25: 105-120

[57]

Poly TN, Islam MM, Yang HC, Li YJ. Association between benzodiazepine use and risk of hip fracture in the elderly people: A meta-analysis of observational studies. Jt. Bone Spine, 2020, 87: 241-249

[58]

van de Ven LI, et al.. Association between use of antidepressants or benzodiazepines and the risk of subsequent fracture among those aged 65+ in the Netherlands. Osteoporos. Int., 2018, 29: 2477-2485

[59]

Treves N, Perlman A, Kolenberg Geron L, Asaly A, Matok I. Z-drugs and risk for falls and fractures in older adults-a systematic review and meta-analysis. Age Ageing, 2018, 47: 201-208

[60]

Wang GH, et al.. Injurious fall risk differences among older adults with first-line depression treatments. JAMA Netw. Open, 2024, 7: e2435535

[61]

Shimizu Y, Taga M, Takahashi Y, Yamamoto Y, Masauji T. Risk assessment of accidental falls in patients taking trazodone, quetiapine, or risperidone for insomnia: A single-center, case-control study. Neuropsychopharmacol. Rep., 2022, 42: 532-537

[62]

Amari DT, et al.. Fall risk, healthcare resource use, and costs among adult patients in the United States Treated for Insomnia with Zolpidem, Trazodone, or Benzodiazepines: a retrospective cohort study. Adv. Ther., 2022, 39: 1324-1340

[63]

Bronskill SE, et al.. Low-dose Trazodone, Benzodiazepines, and fall-related injuries in nursing homes: a matched-cohort study. J. Am. Geriatr. Soc., 2018, 66: 1963-1971

[64]

Pan G, Ni L, Yan H, Yao L. Association between the use of orexin receptor antagonists and falls or fractures: A meta-analysis. J. Psychiatr. Res., 2024, 176: 393-402

[65]

Midzak A, Zirkin B, Papadopoulos V. Translocator protein: pharmacology and steroidogenesis. Biochem Soc. Trans., 2015, 43: 572-578

[66]

Lee DH, et al.. Effects of peripheral benzodiazepine receptor ligands on proliferation and differentiation of human mesenchymal stem cells. J. Cell Physiol., 2004, 198: 91-99

[67]

Zhang T, et al.. Midazolam suppresses osteogenic differentiation of human bone marrow-derived mesenchymal stem cells. Eur. Rev. Med. Pharm. Sci., 2014, 18: 1411-1418

[68]

Chen YC, Wu KC, Huang BM, So EC, Wang YK. Midazolam inhibits chondrogenesis via peripheral benzodiazepine receptor in human mesenchymal stem cells. J. Cell Mol. Med., 2018, 22: 2896-2907

[69]

Smit AE, Binda TRR, van Heemst D, Noordam R, Winter EM. Self-reported sleep disturbances are associated with osteoporosis: multivariable-adjusted and Mendelian randomization analyses in UK Biobank. JBMR, 2025, 9ziaf085

[70]

Kim BK, Choi YJ, Chung YS. Other than daytime working is associated with lower bone mineral density: the Korea National Health and Nutrition Examination Survey 2009. Calcif. Tissue Int., 2013, 93: 495-501

[71]

Qian Y, Mao J. The association between night shift work and osteoporosis risk in adults: A cross-sectional analysis using NHANES. Heliyon, 2024, 10 ArticleID: e28240

[72]

Quevedo I, Zuniga AM. Low bone mineral density in rotating-shift workers. J. Clin. Densitom., 2010, 13: 467-469

[73]

Feskanich D, Hankinson SE, Schernhammer ES. Nightshift work and fracture risk: the Nurses’ Health Study. Osteoporos. Int., 2009, 20: 537-542

[74]

Bukowska-Damska A, Skowronska-Jozwiak E, Kaluzny P, Lewinski A, Peplonska B. Night shift work and osteoporosis among female blue-collar workers in Poland - a pilot study. Chronobiol. Int., 2020, 37: 910-920

[75]

Martelli M, et al.. Night shift work and serum markers of bone turnover in male shift workers. Chronobiol. Int., 2023, 40: 1270-1278

[76]

Bukowska-Damska A, Skowronska-Jozwiak E, Kaluzny P, Lewinski A. Night shift work and osteoporosis - bone turnover markers among female blue-collar workers in Poland. Chronobiol. Int., 2022, 39: 818-825

[77]

Swanson CM, et al.. Sleep restriction with circadian disruption negatively alter bone turnover markers in women. J. Clin. Endocrinol. Metab., 2020, 105: 2456-2463

[78]

Swanson CM, et al.. Bone turnover markers after sleep restriction and circadian disruption: a mechanism for sleep-related bone loss in humans. J. Clin. Endocrinol. Metab., 2017, 102: 3722-3730

[79]

Swanson CM, et al.. Rapid suppression of bone formation marker in response to sleep restriction and circadian disruption in men. Osteoporos. Int., 2019, 30: 2485-2493

[80]

Rogers TS, et al.. Rest-activity circadian rhythms and bone mineral density in elderly men. Bone Rep., 2017, 7: 156-163

[81]

Rogers TS, et al.. Rest-activity patterns and falls and fractures in older men. Osteoporos. Int, 2017, 28: 1313-1322

[82]

Zhao H, et al.. Rest-activity circadian rhythms and osteoporosis: a prospective cohort and Mendelian randomization study. Bone, 2025, 198 ArticleID: 117521

[83]

Qin Y, et al.. Circadian clock genes as promising therapeutic targets for bone loss. Biomed. Pharmacother., 2023, 157 ArticleID: 114019

[84]

Wu QY, et al.. Emerging role of circadian rhythm in bone remodeling. J. Mol. Med., 2019, 97: 19-24

[85]

Xu C, et al.. Circadian clock regulates bone resorption in mice. J. Bone Min. Res., 2016, 31: 1344-1355

[86]

Zhou X, et al.. BMAL1 deficiency promotes skeletal mandibular hypoplasia via OPG downregulation. Cell Prolif., 2018, 51 ArticleID: e12470

[87]

Kim K, Kim JH, Kim I, Seong S, Kim N. Rev-erbα negatively regulates Osteoclast and Osteoblast differentiation through p38 MAPK signaling pathway. Mol. Cells, 2020, 43: 34-47

[88]

Vasey, C., McBride, J., Penta, K. Circadian rhythm dysregulation and restoration: the role of Melatonin. Nutrients. 13, 3480 (2021).

[89]

Bagherifard A, et al.. Melatonin and bone-related diseases: an updated mechanistic overview of current evidence and future prospects. Osteoporos. Int., 2023, 34: 1677-1701

[90]

Egstrand S, et al.. A molecular circadian clock operates in the parathyroid gland and is disturbed in chronic kidney disease associated bone and mineral disorder. Kidney Int., 2020, 98: 1461-1475

[91]

Rendina-Ruedy E, Rosen CJ. Parathyroid hormone (PTH) regulation of metabolic homeostasis: An old dog teaches us new tricks. Mol. Metab., 2022, 60 ArticleID: 101480

[92]

Liu, P. Y. Rhythms in cortisol mediate sleep and circadian impacts on health. Sleep. 47, zsae151 (2024).

[93]

Bensreti H, et al.. Update on the role of glucocorticoid signaling in osteoblasts and bone marrow adipocytes during aging. Curr. Osteoporos. Rep., 2023, 21: 32-44

[94]

Gamble KL, Berry R, Frank SJ, Young ME. Circadian clock control of endocrine factors. Nat. Rev. Endocrinol., 2014, 10: 466-475

[95]

Luo B, et al.. Circadian rhythms affect bone reconstruction by regulating bone energy metabolism. J. Transl. Med., 2021, 19 ArticleID: 410

[96]

Scheiermann C, Gibbs J, Ince L, Loudon A. Clocking in to immunity. Nat. Rev. Immunol., 2018, 18: 423-437

[97]

Fischer V, Haffner-Luntzer M. Interaction between bone and immune cells: Implications for postmenopausal osteoporosis. Semin. Cell Dev. Biol., 2022, 123: 14-21

[98]

Zhang L, et al.. Melatonin inhibits adipogenesis and enhances osteogenesis of human mesenchymal stem cells by suppressing PPARγ expression and enhancing Runx2 expression. J. Pineal Res., 2010, 49: 364-372

[99]

Qiu X, et al.. Melatonin rescued reactive oxygen species-impaired osteogenesis of human bone marrow mesenchymal stem cells in the presence of tumor necrosis factor-Alpha. Stem Cells Int, 2019, 2019 ArticleID: 6403967

[100]

Choi JH, et al.. PRMT1 mediates RANKL-induced osteoclastogenesis and contributes to bone loss in ovariectomized mice. Exp. Mol. Med., 2018, 50: 1-15

[101]

Tian Y, Gong Z, Zhao R, Zhu Y. Melatonin inhibits RANKL-induced osteoclastogenesis through the miR-882/Rev-erbα axis in Raw264.7 cells. Int J. Mol. Med., 2021, 47: 633-642

[102]

Tao ZS, Hu XF, Sun T. Melatonin prevents bone loss in osteoporotic rats with valproic acid treatment by anti-inflammatory and anti-oxidative stress. Int. Immunopharmacol., 2024, 141 ArticleID: 112932

[103]

Kotlarczyk MP, et al.. Melatonin osteoporosis prevention study (MOPS): a randomized, double-blind, placebo-controlled study examining the effects of melatonin on bone health and quality of life in perimenopausal women. J. Pineal Res., 2012, 52: 414-426

[104]

Amstrup AK, Sikjaer T, Heickendorff L, Mosekilde L, Rejnmark L. Melatonin improves bone mineral density at the femoral neck in postmenopausal women with osteopenia: a randomized controlled trial. J. Pineal Res., 2015, 59: 221-229

[105]

Maria S, et al.. Melatonin-micronutrients Osteopenia Treatment Study (MOTS): a translational study assessing melatonin, strontium (citrate), vitamin D3 and vitamin K2 (MK7) on bone density, bone marker turnover and health related quality of life in postmenopausal osteopenic women following a one-year double-blind RCT and on osteoblast-osteoclast co-cultures. Aging, 2017, 9: 256-285

[106]

Piriyakhuntorn P, et al.. Melatonin supplementation alleviates bone mineral density decline and circulating oxidative stress in iron-overloaded thalassemia patients. J. Pineal Res., 2025, 77 ArticleID: e70055

[107]

Hardeland, R. Aging, Melatonin, and the pro- and anti-inflammatory networks. Int. J. Mol. Sci. 20, 1223 (2019).

[108]

Watson NF, et al.. Recommended amount of sleep for a healthy adult: a joint consensus statement of the American Academy of Sleep Medicine and Sleep Research Society. Sleep, 2015, 38: 843-844

[109]

Hirshkowitz M, et al.. National Sleep Foundation’s sleep time duration recommendations: methodology and results summary. Sleep. Health, 2015, 1: 40-43

[110]

Moradi S, Shab-Bidar S, Alizadeh S, Djafarian K. Association between sleep duration and osteoporosis risk in middle-aged and elderly women: a systematic review and meta-analysis of observational studies. Metabolism, 2017, 69: 199-206

[111]

Wang D, Ruan W, Peng Y, Li W. Sleep duration and the risk of osteoporosis among middle-aged and elderly adults: a dose-response meta-analysis. Osteoporos. Int, 2018, 29: 1689-1695

[112]

Tian J, Zhang J, Ding L, Qi X. Association between sleep duration and low bone mineral density and osteoporosis: a systematic review and meta-analysis. Calcif. Tissue Int., 2024, 116: 3

[113]

Swanson CM, et al.. Association between objective sleep duration and bone mineral density in older postmenopausal women from the Study of Osteoporotic Fractures (SOF). Osteoporos. Int., 2019, 30: 2087-2098

[114]

Swanson CM, et al.. Sleep duration and bone health measures in older men. Osteoporos. Int., 2021, 32: 515-527

[115]

Petrov, M. E., Liu, L.Mudappathi, R., Whisner, C. M. Actigraphic sleep patterns are associated with bone turnover and bone mineral density among university students. J. Sleep Res. 33, e14192 (2024).

[116]

Beck BR, Daly RM, Singh MA, Taaffe DR. Exercise and Sports Science Australia (ESSA) position statement on exercise prescription for the prevention and management of osteoporosis. J. Sci. Med Sport, 2017, 20: 438-445

[117]

Howe, T. E. et al. Exercise for preventing and treating osteoporosis in postmenopausal women. Cochrane Database Syst. Rev.2011, CD000333 (2011).

[118]

Holick MF. Sunlight and vitamin D for bone health and prevention of autoimmune diseases, cancers, and cardiovascular disease. Am. J. Clin. Nutr., 2004, 80: 1678S-1688SS

[119]

Antza C, Kostopoulos G, Mostafa S, Nirantharakumar K, Tahrani A. The links between sleep duration, obesity and type 2 diabetes mellitus. J. Endocrinol., 2021, 252: 125-141

[120]

Imerb N, Thonusin C, Chattipakorn N, Chattipakorn SC. Aging, obese-insulin resistance, and bone remodeling. Mech. Ageing Dev., 2020, 191 ArticleID: 111335

[121]

Vgontzas AN, et al.. Adverse effects of modest sleep restriction on sleepiness, performance, and inflammatory cytokines. J. Clin. Endocrinol. Metab., 2004, 89: 2119-2126

[122]

Khan MS, Aouad R. The effects of insomnia and sleep loss on cardiovascular disease. Sleep. Med. Clin., 2022, 17: 193-203

[123]

Archer SN, Oster H. How sleep and wakefulness influence circadian rhythmicity: effects of insufficient and mistimed sleep on the animal and human transcriptome. J. Sleep. Res., 2015, 24: 476-493

[124]

Piovezan RD, et al.. Associations between sleep conditions and body composition states: results of the EPISONO study. J. Cachexia Sarcopenia Muscle, 2019, 10: 962-973 Oct

[125]

Cauley JA, et al.. Hypoxia during sleep and the risk of falls and fractures in older men: the Osteoporotic Fractures in Men Sleep Study. J. Am. Geriatr. Soc., 2014, 62: 1853-1859

[126]

Stone KL, et al.. Sleep disturbances and risk of falls in older community-dwelling men: the outcomes of Sleep Disorders in Older Men (MrOS Sleep) Study. J. Am. Geriatr. Soc., 2014, 62: 299-305

[127]

Yilmaz Gokmen G, et al.. Postural stability and fall risk in patients with obstructive sleep apnea: a cross-sectional study. Sleep. Breath., 2021, 25: 1961-1967

[128]

Kaushik S, Wang JJ, Mitchell P. Sleep apnea and falls in older people. J. Am. Geriatr. Soc., 2007, 55: 1149-1150

[129]

Stevens D, et al.. Reduction in fall risk markers following CPAP treatment of obstructive sleep apnoea in people over 65 years. Sleep. Med., 2022, 100: 448-453

[130]

Huang T, Tworoger SS, Redline S, Curhan GC, Paik JM. Obstructive sleep apnea and risk for incident vertebral and hip fracture in women. J. Bone Miner. Res., 2020, 35: 2143-2150

[131]

Liu Y, et al.. High prevalence of vertebral fractures associated with apnea-hypopnea index in patients with recent diagnosis of obstructive sleep apnea. BMC Musculoskelet. Disord., 2025, 26 ArticleID: 881

[132]

Tomiyama H, et al.. Link between obstructive sleep apnea and increased bone resorption in men. Osteoporos. Int., 2008, 19: 1185-1192

[133]

Terzi R, Yılmaz Z. Bone mineral density and changes in bone metabolism in patients with obstructive sleep apnea syndrome. J. Bone Min. Metab., 2016, 34: 475-481 Jul

[134]

Vilovic, M. et al. Bone metabolism parameters and inactive matrix Gla protein in patients with obstructive sleep apnea†. Sleep. 43, zsz243 (2019).

[135]

Deng L, et al.. Association of obstructive sleep apnea with bone metabolism in older adults: a hospital-based study. BMC Musculoskelet. Disord., 2024, 25 ArticleID: 939

[136]

Qiao Y, et al.. Early bone loss in patients with obstructive sleep apnea: a cross-sectional study. BMC Pulm. Med., 2024, 24: 28

[137]

Prabhakar NR, Peng YJ, Nanduri J. Hypoxia-inducible factors and obstructive sleep apnea. J. Clin. Invest., 2020, 130: 5042-5051

[138]

Chen, W. et al. HIF-1α regulates bone homeostasis and angiogenesis, participating in the occurrence of bone metabolic diseases. Cells. 11, 3552 (2022).

[139]

Doi K, et al.. Role of lysine-specific demethylase 1 in metabolically integrating osteoclast differentiation and inflammatory bone resorption through hypoxia-inducible factor 1α and E2F1. Arthritis Rheumatol., 2022, 74: 948-960

[140]

Jelic S, Le Jemtel TH. Inflammation, oxidative stress, and the vascular endothelium in obstructive sleep apnea. Trends Cardiovasc Med., 2008, 18: 253-260

[141]

Korbecki, J. et al. Chronic and cycling hypoxia: drivers of cancer chronic inflammation through HIF-1 and NF-κB activation: a review of the molecular mechanisms. Int. J. Mol. Sci. 22, 10701 (2021).

[142]

Tapp ZM, et al.. Sleep fragmentation engages stress-responsive circuitry, enhances inflammation and compromises hippocampal function following traumatic brain injury. Exp. Neurol., 2022, 353: 114058

[143]

Morrison M, Halson SL, Weakley J, Hawley JA. Sleep, circadian biology and skeletal muscle interactions: Implications for metabolic health. Sleep. Med. Rev., 2022, 66 ArticleID: 101700

[144]

Carpi M, et al.. Continuous positive airway pressure treatment improves bone mineral density in men affected by severe obstructive sleep apnea syndrome. J. Clin. Sleep. Med., 2024, 20: 67-73

[145]

Theorell-Haglöw J, et al.. Changes of vitamin D levels and bone turnover markers after CPAP therapy: a randomized sham-controlled trial. J. Sleep. Res., 2018, 27 ArticleID: e12606

[146]

Liguori C, et al.. Continuous positive airway pressure treatment increases serum Vitamin D levels in male patients with obstructive sleep apnea. J. Clin. Sleep. Med., 2015, 11: 603-607

[147]

Liguori C, et al.. Vitamin D status of male OSAS patients improved after long-term CPAP treatment mainly in obese subjects. Sleep. Med., 2017, 29: 81-85

[148]

Siachpazidou DI, et al.. Serum vitamin D levels in patients with obstructive sleep apnea syndrome and level changes after continuous positive airway pressure therapy. Sleep. Breath., 2021, 25: 657-668

[149]

Kotsiou OS, et al.. Association between Interleukin-6 and vitamin D serum levels in patients with obstructive sleep apnea syndrome and impact of long-term continuous positive airway pressure therapy on biomarker levels. Respir. Physiol. Neurobiol., 2022, 296 ArticleID: 103806

[150]

Loh HH, et al.. Obstructive sleep apnea and vitamin D: an updated systematic review and meta-analysis. Hormones, 2023, 22: 563-580

[151]

Archontogeorgis K, Voulgaris A, Chadia K, Bonelis K, Steiropoulos P. Effect of CPAP therapy on vitamin D status in patients with obstructive sleep apnea and chronic obstructive pulmonary disease overlap syndrome. Sleep. Breath., 2025, 29: 162

[152]

Meliante, P. G. et al. Molecular pathology, oxidative stress, and biomarkers in obstructive sleep apnea. Int. J. Mol. Sci. 24, 5478 (2023).

[153]

Randerath, W. et al. European Respiratory Society guideline on non-CPAP therapies for obstructive sleep apnoea. Eur. Respir. Rev. 30, 210200 (2021).

[154]

Malhotra A, et al.. Tirzepatide for the treatment of obstructive sleep apnea and obesity. N. Engl. J. Med., 2024, 391: 1193-1205

[155]

Minkin C, Jennings JM. Carbonic anhydrase and bone remodeling: sulfonamide inhibition of bone resorption in organ culture. Science, 1972, 176: 1031-1033

[156]

Manconi M, et al.. Restless legs syndrome. Nat. Rev. Dis. Prim., 2021, 7: 80

[157]

Cikrikcioglu MA, et al.. Reduced bone resorption and increased bone mineral density in women with restless legs syndrome. Neurology, 2016, 86: 1235-1241

[158]

Bassetti CLA, et al.. Narcolepsy - clinical spectrum, aetiopathophysiology, diagnosis and treatment. Nat. Rev. Neurol., 2019, 15: 519-539

[159]

Reis MJF, Truzzi GM, Naufel MF, Coelho FMS. Exploring the association between hypocretin-1 levels and bone mineral content in patients with narcolepsy: A cross-sectional study. Sleep. Med., 2024, 121: 375-378

[160]

Chang ET, Lin CL, Chen SF, Hsu CY, Shen YC. Risk of bone fractures in patients with narcolepsy: a nationwide population-based cohort study. Sleep. Med., 2020, 70: 55-59

Funding

This work was supported by the Ministry of Science and Technology of the People’s Republic of China (Grant numbers 2021ZD0201900).

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