For U.S. adults, routine use of sun-protective behaviors is not associated with reduced bone mineral density (BMD) or increased fracture risk, according to a study published online Oct. 27 in JAMA Dermatology.

Mohsen Afarideh, M.D., M.P.H., from the Mayo Clinic in Rochester, Minnesota, and colleagues examined the correlation of sun-protective behaviors with BMD z scores and the prevalence of osteoporotic fractures in a population-based cohort study. Data were included for 3,418 U.S. adults (≥20 years) participating in the 2017 to 2018 cycle of the National Health and Nutrition Examination Survey who completed the dermatology questionnaire.

The researchers found that the prevalence of frequently staying in the shade was 31.6 percent, wearing of long sleeves was 11.8 percent, and sunscreen use was 26.1 percent. In the multivariate models, there was no correlation observed for use of individual sun-protective behaviors with diminished site-specific and total BMD z scores. In the multivariate model, there was an association identified between moderate-to-frequent staying in the shade and a reduced prevalence of spine fractures (odds ratio, 0.19).

"Sun protection may actually be associated with a modest decrease in the prevalence of osteoporotic fractures, possibly owing to vigilant behaviors, and should be encouraged in all patients, including those otherwise at risk for decreased BMD and fractures," the authors write.

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