A Japanese cohort study of more than 900,000 adults found that skipping breakfast and eating dinner shortly before bedtime were each associated with a higher risk of osteoporotic fractures. The combination of both habits further increased risk.
Researchers analyzed health checkup and claims data from the DeSC database, which includes records from multiple national health insurance systems. Patients aged 20 years or older who underwent screenings from 2014 to 2022 were included. Those with prior osteoporosis or fractures in the year before enrollment were excluded. Lifestyle questionnaires were completed at baseline, and fracture outcomes were identified through claims for hip, vertebral, humeral, and distal forearm fractures.
The median age of patients was 67 years, and just over half were women. Median follow-up was 3 years.
During this time, 28,196 major osteoporotic fractures occurred, an incidence rate of 11 per 1,000 person-years. Vertebral fractures were most common, followed by distal forearm, humeral, and hip fractures.
Skipping breakfast was linked to an 18% higher risk of osteoporotic fracture, while eating dinner within 2 hours of bedtime was linked to an 8% increase. Both habits were tied to hip, vertebral, and humeral fractures but not distal forearm fractures. When combined, skipping breakfast and late dinners carried a 23% higher risk compared with patients who reported neither habit.
Other lifestyle factors also influenced risk. Smoking was associated with higher fracture risk, while daily alcohol consumption, regular exercise, faster walking speed, and sufficient sleep were linked to lower overall risk. However, distal forearm fractures were more frequent among patients who reported daily alcohol intake, regular exercise, or fast gait speed. Women had more than double the risk compared with men, particularly for distal forearm fractures. Fracture risk increased with age, while higher body mass index showed a modest protective effect.
“Our study is the first to demonstrate that skipping breakfast and having a late dinner are independently associated with a higher risk of osteoporotic fracture, using a large health checkup cohort,” Hiroki Nakajima, PhD, of the Department of Diabetes and Endocrinology, Nara Medical University, Japan, and colleagues. They noted that late meals may elevate cortisol and oxidative stress, while skipping breakfast has been linked to lower vitamin D and calcium intake and circadian rhythm disruption, all of which may impair bone metabolism.
Limitations included reliance on self-reported lifestyle data, lack of family history of osteoporosis, and inability to distinguish fractures caused by high-energy trauma from those due to fragility. Conditions diagnosed more than 1 year before enrollment were not captured.
Full disclosures can be found in the study.
Source: Endocrine Society