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However, no prospective study to date has investigated the association between OSA and fracture risk in women. We conducted a prospective study examining the relation between OSA and risk of incident vertebral fracture (VF) and hip fracture (HF) in the Nurses' Health Study. History of physician-diagnosed OSA was assessed by self-reported questionnaires. A previous validation study demonstrated high concordance between self-reports and medical record identification of OSA. OSA severity was further categorized according to the presence or absence of self-reported sleepiness. Self-reports of VF were confirmed by medical record review. Self-reported HF was assessed by biennial questionnaires. Cox proportional-hazards models estimated the hazard ratio for fracture according to OSA status, adjusted for potential confounders, including BMI, physical activity, calcium intake, history of osteoporosis, and falls, and use of sleep medications. Among 55,264 women without prior history of fracture, physician-diagnosed OSA was self-reported in 1.3% in 2002 and increased to 3.3% by 2012. Between 2002 and 2014, 461 incident VF cases and 921 incident HF cases were documented. The multivariable-adjusted hazard ratio (HR) for confirmed VF for women with history of OSA was 2.00 (95% CI, 1.29\u20133.12) compared with no OSA history, with the strongest association observed for OSA with daytime sleepiness (HR 2.86; 95% CI, 1.31\u20136.21). No association was observed between OSA history and self-reported HF risk (HR 0.83; 95% CI, 0.49\u20131.43). History of OSA is independently associated with higher risk of confirmed VF but did not have a statistically significant association with self-reported HF in women. Further research is warranted in understanding the role of OSA and intermittent hypoxia in bone metabolism and health that may differ by fracture site. \u00a9 2020 American Society for Bone and Mineral Research (ASBMR).<\/jats:p>","DOI":"10.1002\/jbmr.4127","type":"journal-article","created":{"date-parts":[[2020,11,11]],"date-time":"2020-11-11T13:23:59Z","timestamp":1605101039000},"page":"2143-2150","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":29,"title":["Obstructive Sleep Apnea and Risk for Incident Vertebral and Hip Fracture in Women"],"prefix":"10.1093","volume":"35","author":[{"given":"Tianyi","family":"Huang","sequence":"first","affiliation":[{"name":"Harvard Medical School Harvard University Boston MA USA"},{"name":"Channing Division of Network Medicine, Department of Medicine Brigham and Women's Hospital Boston MA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shelley S","family":"Tworoger","sequence":"additional","affiliation":[{"name":"Department of Epidemiology Harvard T. H. Chan School of Public Health, Harvard University Boston MA USA"},{"name":"Department of Cancer Epidemiology Moffitt Cancer Center Tampa FL USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Susan","family":"Redline","sequence":"additional","affiliation":[{"name":"Harvard Medical School Harvard University Boston MA USA"},{"name":"Division of Sleep and Circadian Disorders, Department of Medicine Brigham and Women's Hospital Boston MA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gary C","family":"Curhan","sequence":"additional","affiliation":[{"name":"Department of Epidemiology Harvard T. H. Chan School of Public Health, Harvard University Boston MA USA"},{"name":"Harvard Medical School Harvard University Boston MA USA"},{"name":"Renal Division, Department of Medicine Brigham and Women's Hospital Boston MA USA"},{"name":"Channing Division of Network Medicine, Department of Medicine Brigham and Women's Hospital Boston MA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1315-5445","authenticated-orcid":false,"given":"Julie M","family":"Paik","sequence":"additional","affiliation":[{"name":"Harvard Medical School Harvard University Boston MA USA"},{"name":"New England Geriatric Research Education and Clinical Center VA Boston Healthcare System Boston MA USA"},{"name":"Renal Division, Department of Medicine Brigham and Women's Hospital Boston MA USA"},{"name":"Channing Division of Network Medicine, Department of Medicine Brigham and Women's Hospital Boston MA 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