High prevalence of vertebral fractures associated with apnea-hypopnea index in patients with recent diagnosis of obstructive sleep apnea

Obstructive sleep apnea (OSA) has adverse effects on bones; however, the incidence of vertebral fractures (VFs) in patients with OSA remains uncertain. Additionally, there is an ongoing debate about whether VFs represent an early occurrence in OSA’s natural progression. This study aimed to assess the prevalence and determinants of VFs in patients newly diagnosed with OSA. In this cross-sectional case–control study, we recruited 110 patients (74 male and 36 female) recently diagnosed with OSA (based on overnight polysomnography) and compared them with a control group of individuals without secondary osteoporosis. The collected clinical data included demographic, clinical, biochemical data. The VFs were assessed using lateral chest radiography. We found that patients with OSA had a higher incidence of VFs than healthy controls (24.5% vs. 12.5%). The OSA patients with VFs had significantly higher systolic blood pressure, wake time, and N1 stage than those without VF (P < 0.05). Apnea-hypopnea index (AHI) and oxygen desaturation index were significantly higher in OSA patients with VFs than in those without VFs (P < 0.001). In the multiple logistic regression analysis, AHI emerged as a predictor of the risk of VFs in these patients (OR 1.088, 95%CI 1.019–1.162, P = 0.011), and the optimal threshold for AHI prediction of VFs was 21.6 events per hour. This is the first study reporting that a high incidence of VFs was found in recently diagnosed OSA patients. VFs are an early manifestation of OSA and related to AHI. VFs assessment should be included in the workup during OSA diagnosis.