title: Sleep disorders increase the risk of osteoporosis: a nationwide population-based cohort study.
abstract: BACKGROUND
  This study evaluated the relationship between sleep disorders (SDs) and osteoporosis risk in Taiwan.
  
  
  METHODS
  From the Taiwan National Health Insurance data, we identified 44,690 newly diagnosed SD patients (846 with apnea and 43,844 without) from 1998 to 2001 and 89,380 comparisons without SD in the same period frequency matched by sex, age and diagnosis year. Incident osteoporosis was measured by the end of 2010.
  
  
  RESULTS
  Patients with apnea-SD and nonapnea SD exhibited a higher osteoporosis incidence rate than did the comparisons (9.97 and 13.3 vs. 6.77 per 1000 person-years, respectively). The Cox method estimated adjusted hazard ratio (HR) of osteoporosis was 2.98 (95% confidence interval [CI] = 2.36-3.74) in apnea-SD patients, compared with 2.76 (95% CI = 2.64-2.88) in nonapnea-SD patients after controlling for sex, age, comorbidities, and treatment. Greater HRs of osteoporosis were observed for female patients (4.00, 95% CI = 3.72-4.29) and those aged >64 years (42.0, 95% CI = 33.5-52.7) in the apnea SD sub-cohort. Apnea SD was associated with the highest risk of osteoporosis without fracture compared with both the nonapnea SD sub-cohort and comparisons.
  
  
  CONCLUSIONS
  Patients with sleep disorders have an elevated risk of osteoporosis, especially for women and the elderly.
authors.affiliation: Department of Anesthesiology, Buddhist Tzu Chi General Hospital, Taichung Branch, Taichung, Taiwan.
authors.forename: Chia-Ming
authors.initials: CM
authors.lastname: Yen
authors.affiliation: Department of Nuclear Medicine, New Taipei City Hospital, Sanchong Branch, Taipei, Taiwan.
authors.forename: Chi-Ling
authors.initials: CL
authors.lastname: Kuo
authors.affiliation: Department of Nuclear Medicine, E-DA Hospital, Kaohsiung, Taiwan.
authors.forename: Ming-Chia
authors.initials: MC
authors.lastname: Lin
authors.affiliation: Department of Oral and Maxillofacial Surgery, Buddhist Tzu Chi General Hospital, Taichung Branch, Taichung, Taiwan.
authors.forename: Chun-Feng
authors.initials: CF
authors.lastname: Lee
authors.affiliation: Department of Nursing, Central Taiwan University of Science and Technology, Taichung, Taiwan.
authors.forename: Kuan-Yu
authors.initials: KY
authors.lastname: Lin
authors.affiliation: Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan.
authors.forename: Cheng-Li
authors.initials: CL
authors.lastname: Lin
authors.affiliation: Department of Medical Research, Taichung Veterans General Hospital, Taiwan.
authors.forename: Shih-Ni
authors.initials: SN
authors.lastname: Chang
authors.affiliation: Graduate Institute of Clinical Medical Science and School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan. Electronic address: fcsung@mail.cmu.edu.tw.
authors.forename: Fung-Chang
authors.initials: FC
authors.lastname: Sung
authors.affiliation: Graduate Institute of Clinical Medical Science and School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan; Department of Nuclear Medicine and PET Center, China Medical University Hospital, Taichung, Taiwan. Electronic address: d10040@mail.cmuh.org.tw.
authors.forename: Chia-Hung
authors.initials: CH
authors.lastname: Kao
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D005260:Female; D006801:Humans; D015994:Incidence; D053208:Kaplan-Meier Estimate; D008297:Male; D010024:Osteoporosis / Q000453:epidemiology / Q000209:etiology*; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D012737:Sex Factors; D012893:Sleep Wake Disorders / Q000150:complications* / Q000453:epidemiology; D013624:Taiwan / Q000453:epidemiology
keywords: National health insurance; Nonapnea; Osteoporosis; Population-based retrospective cohort study; Sleep disorder