title: Bone loss in obesity and obstructive sleep apnea: a review of literature.
abstract: BACKGROUND
  Obstructive sleep apnea (OSA) is a common sleep-related respiratory disorder. It is associated with many endocrinopathies including hypogonadotropic hypogonadism, hypercortisolism, and glucose intolerance that may lead to bone loss with secondary osteoporosis.
  
  
  METHODS
  We report the case of a 41-year-old man who presented with bilateral 9th rib fractures and was found to have obstructive sleep apnea and osteoporosis. We also present a literature review on this topic.
  
  
  RESULTS
  OSA can lead to bone loss through various mechanisms. Some are shared with obesity, including hypogonadism, altered adrenergic tone, inflammation, oxidative stress, vitamin D deficiency and diabetes mellitus; others are specific to OSA, such as hypoxia and altered glucocorticoids regulation.
  
  
  CONCLUSIONS
  There are no guidelines on screening for osteoporosis in OSA. Further research is needed to assess the incidence of bone loss and fractures in OSA.
authors.affiliation: Division of Endocrinology at the American University of Beirut, Beirut Lebanon.
authors.forename: Marlene
authors.initials: M
authors.lastname: Chakhtoura
authors.affiliation: Division of Endocrinology at the American University of Beirut, Beirut Lebanon.
authors.forename: Mona
authors.initials: M
authors.lastname: Nasrallah
authors.affiliation: Division of Pulmonary, Sleep and Critical Care Medicine at the American University of Beirut, Beirut Lebanon.|Pulmonary Center at Boston University School of Medicine, Boston, MA.
authors.forename: Hassan
authors.initials: H
authors.lastname: Chami
mesh_terms: D000328:Adult; D006801:Humans; D008297:Male; D009765:Obesity / Q000150:complications*; D010024:Osteoporosis / Q000150:complications*; D012307:Risk Factors; D020181:Sleep Apnea, Obstructive / Q000150:complications*
keywords: bone loss; fracture; hypoxia; obesity; obstructive sleep apnea