Association between sleep quality and bone mineral density in Chinese women vary by age and menopausal status

Sleep quality is closely related to bone health. Aging and estrogen deficiency are known determinants of poor sleep quality and osteoporosis. However, the impact of aging and menopause on the associations between sleep quality and bone mineral density (BMD) remains unclear. This study aimed to examine the association between sleep quality and BMD in Chinese women vary by age groups and menopausal status. A total of 2067 women aged 18–80 years were included. Sleep quality was measured using the Pittsburgh Sleep Quality Index (PSQI) and the score >7 was indicative of poor sleep quality. BMD was determined using the dual-energy X-ray absorptiometry. Participants were categorized into three age groups. Multiple linear regression models were conducted to evaluate the associations between sleep quality and BMD. Covariates included in the models were age, menopausal status, weight, height, percent body fat, physical activity, alcohol drinking, calcium supplement use, marital status, education and metabolic diseases. We observed that poor sleep quality was correlated to low total BMD and legs BMD in middle-aged women after adjusting for potential confounders. Furthermore, when we reran the regression models based on menopausal status in middle-aged women, significant associations between BMD and sleep quality were observed in premenopausal and early postmenopausal groups. Our findings showed a more robust association between sleep quality and BMD in premenopausal and early menopausal groups. Further studies should be conducted to explore whether sleep quality intervention would improve bone health of women in these periods and prevent osteoporosis in their late life. •Poor sleep quality was associated with low total and regional bone mineral density in middle-aged women.•The association was more robust in pre- and early menopausal women.•Sleep quality intervention in the pre- and early menopausal period might improve bone health of women and prevent osteoporosis later in life.