Silent Connection: Bone Health and Sleep Apnea

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Your sleep quality may impact more than your nightly rest; recent research by University at Buffalo School Of Dental Medicine researchers suggests a connection between obstructive sleep apnea and low bone-mineral density in adults. This link is particularly significant, as low bone-mineral density indicates the silent disease, osteoporosis, which affects bone strength and resilience. This article will explore the study’s findings, shedding light on the potential implications for oral health and orthodontic treatments.

What Is Sleep Apnea?

Sleep apnea is a sleep disorder characterized by interruptions in breathing during sleep. These mini interruptions, known as apneas, can last a few seconds to minutes and may occur multiple times throughout the night. The most common type of sleep apnea is obstructive sleep apnea (OSA), which occurs when the muscles in the throat relax excessively, leading to a partial or complete airway blockage.

Key symptoms of sleep apnea include:

  • Breathing Interruptions: Individuals with sleep apnea experience pauses in breathing during sleep, leading to a drop in oxygen levels in the blood.
  • Loud Snoring: One of the noticeable symptoms is often loud snoring. However, it is important to note that not everyone who snores has sleep apnea.
  • Abrupt Awakening: Sufferers may awaken abruptly with a choking or gasping sound as they resume breathing.
  • Daytime Sleepiness: Due to a constantly disrupted sleep, individuals dealing with sleep apnea often experience excessive daytime sleepiness, fatigue, and difficulty concentrating.
  • Morning Headaches: Waking up with a headache is another potential symptom.
  • Irritability: Sleep apnea can contribute to irritability and mood changes.
  • Risk Factors: Factors such as obesity, older age, being male, having a family history of sleep apnea, and certain medical conditions can increase the risk.

It is important to diagnose and treat sleep apnea, as untreated cases can lead to serious health issues, including hypertension, heart problems, diabetes, and daytime fatigue that may contribute to accidents. Diagnosis often involves a sleep study and treatment options range from lifestyle changes and dental appliances to continuous positive airway pressure (CPAP) devices.

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What Is Osteoporosis?

Osteoporosis is a medical condition characterized by the weakening of bones, leading to increased fragility and a higher risk of fractures. Bones are living tissues that undergo a continuous process of breaking down and rebuilding themselves. In individuals with osteoporosis, the creation of new bone does not keep up with the removal of old bone.

As a result, bones become porous and brittle, making them more susceptible to fractures, especially in areas like the hips, spine, and wrists. Fractures associated with osteoporosis can occur with simple activities such as bending over, sneezing, or minor falls.

Key features and factors associated with osteoporosis include:

  • Bone Density Loss: Osteoporosis is often characterized by decreased bone density.
  • Risk of Fractures: The weakened bones are prone to fractures, and these fractures can have significant consequences, particularly in the elderly population.
  • Common in Postmenopausal Women: Women, especially after menopause, are at a higher risk of developing osteoporosis due to the decrease in estrogen, a hormone that helps protect bone density.
  • Age Related: While osteoporosis can affect people of any age, it is more common in older adults.
  • Genetic Factors: A family history of osteoporosis can increase the risk.
  • Lifestyle Factors: Lack of physical activity, smoking, excessive alcohol consumption, and a diet low in calcium and vitamin D can contribute to the development of osteoporosis.

Preventive measures and management strategies for osteoporosis often include a combination of a healthy diet rich in calcium and vitamin D, regular weight-bearing exercise, lifestyle changes, and medications to improve bone density. Early detection through bone density testing is crucial for effective management and reducing the risk of fractures associated with osteoporosis.

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Normal Bone Vs. Osteoporosis Bone

The Study: Exploring the Relationship

Published in The Journal of Craniomandibular and Sleep Practice, the research utilized cone beam computed tomography (CBCT) to measure bone density in the head and neck of 38 adult participants, half of whom had obstructive sleep apnea. Controlling for age, sex, and weight, the study revealed a notable association between obstructive sleep apnea and significantly lower bone mineral density.

Understanding the Mechanism

Obstructive sleep apnea is characterized by breathing difficulties during sleep, leading to hypoxia, inflammation, oxidative stress, and altered breathing patterns. These factors, when chronic, may negatively impact bone metabolism and density. Thikriat Al-Jewair, the senior author, emphasizes the potential long-term effects on bone health due to the chronic nature of these symptoms.

Implications for Oral Health

Low bone-mineral density not only heightens the risk of fractures but also poses challenges to oral health. Loose teeth and potential failures of dental implants become concerns. Al-Jewair, an expert in orthodontics, suggests that orthodontic treatment plans may need to consider a patient’s sleep apnea diagnosis, emphasizing the importance of CBCT imaging as a screening tool for assessing bone mineral density.

Orthodontic Considerations

Al-Jewair highlights the study’s potential influence on orthodontic treatment planning and management. With a sleep apnea diagnosis, orthodontists could use CBCT imaging to screen for low bone-mineral density, enabling them to inform patients about potential risks and outcomes. This proactive approach empowers patients to seek further consultation with physicians and dentists, fostering collaboration in managing sleep-related issues and orthodontic treatments.

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The Road Ahead: Future Research

While this study provides valuable insights, Al-Jewair emphasizes the need for future research with larger sample sizes. This ongoing study aims to increase our understanding of the intricate relationship between obstructive sleep apnea and low bone-mineral density, paving the way for more informed orthodontic and dental practices and comprehensive patient care.


In dentistry, this newfound link between obstructive sleep apnea and low bone-mineral density adds a new dimension to our understanding of oral health. As research progresses, orthodontists and dentists may increasingly integrate sleep apnea considerations into their treatment strategies, enhancing patient care and overall treatment outcomes.

Author Biomarielaina perrone dds las vegas nv

Marielaina Perrone, DDS, is a highly experienced and dedicated dental professional passionate about delivering exceptional patient care. With over 20 years of experience in the dental industry, Dr. Perrone is widely regarded as a leading authority in her field, with a reputation for providing innovative solutions and personalized care to her patients.

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