Impact of sleep duration on bone mineral density and osteoporosis risk: A systematic review and meta-analysis

Abstract

Background and Objective: Poor sleep has been linked to numerous adverse health outcomes. However, the impact of sleep quality on bone health remains unclear. This systematic review and meta-analysis aimed to evaluate the link between the duration of sleep and the risk of osteoporosis and low bone mineral density (BMD).

Methodology: A comprehensive literature search was performed in PubMed, EMBASE, the Cochrane Library, and Scopus from inception till June 30, 2025 to identify studies examining the relationship between sleep duration and bone health outcomes. The primary effect measures were odds ratios (ORs) with 95% confidence intervals (CIs) for osteoporosis and low BMD. Pooled estimates were calculated using random-effects models, and both qualitative and quantitative syntheses were conducted.

Results: Thirty eligible studies were included. Sleeping ≤6 hours was associated with high risk of osteoporosis (OR 1.58; 95% CI, 1.29–1.94; I²=35%) and low BMD (OR 1.49; 95% CI, 1.09–2.03; I²=81%). Sleep durations of 6–8 hours were not significantly associated with osteoporosis risk (OR 1.06; 95% CI, 0.94–1.19; I²=76%). In contrast, sleeping 8–9 hours was associated with a moderate increase in risk (OR 1.25; 95% CI, 1.11–1.40; I²=86%), while sleeping ≥9 hours showed a non-significant trend toward increased risk (OR 1.38; 95% CI, 0.95–2.01; I²=69%). Subgroup analyses of cohort studies demonstrated consistent associations with lower heterogeneity.

Conclusions: Both short and long sleep durations are associated with an increased risk of osteoporosis and low bone mineral density, whereas a sleep duration of 6–8 hours appears to be optimal for bone health. Sleep duration emerges as a potentially modifiable target for osteoporosis prevention and warrants further mechanistic and interventional research.