Obstructive Sleep Apnea (OSA): Linked to Osteoporosis, Osteoarthritis, and More

Last updated: September 7th, 2023

What is Obstructive Sleep Apnea?

Obstructive Sleep Apnea (OSA) is classified as a sleep-related breathing disorder and it affects nearly 25% of adults 30 years and older. The condition occurs when the airway becomes obstructed during sleep which causes breathing pauses and arouses the body to awaken throughout the night in order to stimulate the airway to clear the obstruction and resume normal breathing. This perpetual cycle occurs throughout the night, causing the affected person to wake up feeling tired and lack energy throughout the day.

The issue with OSA is that stopped breathing, even momentarily, causes carbon dioxide levels to rise and oxygen levels to fall which can lead to a number of other conditions. In addition, the lack of quality sleep leads to daytime sleepiness which has a multi-million dollar economic impact due to lost productivity as well as workplace and auto accidents.

What is Osteoporosis and How Does It Relate To OSA?

Osteoporosis is a common bone disease that occurs when bone density is reduced, causing bones to become weak and brittle. It's most common in people who are older than 50 and the diagnosis often comes as a surprise after one breaks a bone. It's estimated that over fifty million Americans are affected by this condition. The disease is more common in women – affecting nearly 50% while only 25% of men are affected.

Injuries that are common in those with Osteoporosis include broken hips, wrist, or spine although breakage can occur in a number of other areas. Serious complications can occur after an older person breaks a hip, which is one of the reasons why this condition should be treated soon after discovery.

Osteoporosis can be detected by conducting a bone density test. When examined closely under a microscope, a normal bone structure appears as a honeycomb with tissues formed tightly together. With Osteoporosis, the “holes” become larger due to tissue loss, resulting in bones that are more prone to breaking.

Recent research has found a strong link between sleep apnea and osteoporosis. The results of the research showed that having sleep apnea may increase your risk of developing Osteoporosis by 2.7 times. ‘While researchers are not completely sure how the two conditions are related, there are a few theories.

One theory has to do with the acidic environment that is caused by oxygen deprivation. As mentioned earlier, with OSA, breathing stops which causes not only a rise in CO2 but also a drop in blood oxygen levels. When oxygen levels are lowered, it causes inflammation which increases acidity in the body which can promote bone loss.

The other theory has to do with the consequences of lack of quality sleep. During sleep, our bodies go into “repair mode”. With OSA, we never fully achieve deep sleep and heart rhythm can be affected which can cause bone metabolism imbalances and ultimately bone loss.

What is Osteoarthritis & Rheumatoid Arthritis and How Does It Relate To OSA?

Yet another common medical condition is being linked with sleep apnea – Arthritis.

Rheumatoir Arthritis (RA) and Osteoarthritis (OA) are two kinds of arthritis that are often confused with one another, however they are quite different. OA, sometimes called Degenerative Arthritis, is the most common form of arthritis and it's mainly caused by the aging process. It typically affects the joints in the knees, hips, hands, and other parts of the body. On the other hand, RA is an autoimmune disease which can affect almost any joint in the body. It's caused by an overactive immune system which leads to chronic inflammation.

The interesting thing about these two conditions is that they are now linked to OSA. In fact, recent medical studies have found that about 50 percent of people with arthritis also have OSA. The research has shown that people with OSA have 2.4 times greater risk of developing arthritis, both OA and RA.

The studies also showed that the risk of arthritis increases as the severity of OSA increases. With moderate OSA, the likelihood of developing arthritis is 1.45 times, while severe OSA increases the likelihood of developing arthritis by 3.3 times.

Recent research is now looking into why those with OSA have a increased likelihood of developing arthritis. There are a few theories. One thought is that during sleep, the body is in a “rest mode” which means it's not repairing itself. With OSA, we struggle to get in this rest mode which can lead to the body not being able to fight inflammation and arthritis.

Another thought is that OSA leads to Low oxygen levels which can cause abnormal cell signaling and an immune response that may trigger the body to attack the joints, resulting in an inflammatory response.


The relationship between OSA and medical conditions including Osteoporosis and Osteoarthritis is not well understood yet, however recent medical research has established a strong link between the two conditions. As we continue to learn more about these relationships, it's important for both patients and health care providers to monitor the symptoms of snoring and sleep apnea, as they can be indicators of underlying medical conditions.

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