Osteoporosis Is Linked to a Higher Risk of Hearing Loss in Older Adults, Nationwide Study Finds

A nationwide study of more than 663,000 older adults links osteoporosis to a 34 percent higher risk of hearing loss, with common bone drugs showing a protective effect.

Bones and hearing might seem unrelated, but the ear depends on some of the smallest and most delicate bones in the body. When something disturbs bone health throughout the skeleton, researchers have long suspected the ear may not be spared.

A new study published in the Journal of the American Geriatrics Society puts that suspicion to one of its largest tests yet, following hundreds of thousands of older adults to ask whether osteoporosis raises the risk of hearing loss, and whether treating it changes that risk.

Background: Why the Researchers Looked at This

Osteoporosis is a condition in which bones gradually lose density and become fragile, making fractures far more likely. It affects a large share of adults over 65, especially women after menopause. A fragility fracture is a break that happens from a minor fall or bump that healthy bone would normally withstand.

Hearing depends on bone in two ways. The middle ear contains the three tiniest bones in the body, which physically carry sound to the inner ear. The cochlea, the organ that converts sound into nerve signals, is itself encased in dense bone. Earlier research hinted that people with weakened bones develop hearing problems more often, but the studies were small and could not say whether osteoporosis medication makes any difference.

The research team wanted to answer both questions at national scale: does osteoporosis raise hearing loss risk, and do two widely used bone treatments, zoledronic acid and denosumab, change that risk?

How the Study Was Done

The researchers used Taiwan's National Health Insurance Research Database, which covers nearly the entire population, and looked at records from 2011 to 2017. They identified 331,867 adults aged 65 and older with osteoporosis or fragility fractures and matched each of them to a similar person without those conditions, pairing people by age, sex, and overall health burden so the comparison would be fair.

For the treatment question, they compared three equal groups of 21,811 patients each: people treated with zoledronic acid, people treated with denosumab, and people who received no bone medication. They then tracked who went on to receive a new diagnosis of hearing loss, adjusting the numbers for other illnesses that could cloud the picture.

What the Researchers Found

Older adults with osteoporosis or fragility fractures developed hearing loss significantly more often than their matched peers. After adjustment, their risk was 34 percent higher, a result the authors report with high statistical confidence.

Treatment appeared to matter. Patients on zoledronic acid had a 13 percent lower risk of hearing loss than untreated patients, and those on denosumab had a 9 percent lower risk. The protective association with zoledronic acid held for both men and women.

Denosumab showed a notable wrinkle: its link to lower hearing loss risk reached statistical significance only in men. The authors do not claim to know why, and flag it as a question for future work.

Taken together, the pattern supports the idea that skeletal health and ear health are connected, and suggests that protecting bone may also help protect hearing in later life.

What It Means for People with Hearing Loss

For the millions of older adults managing osteoporosis, this study adds hearing to the list of things worth watching. A person with weakened bones who notices muffled conversation, frequent requests to repeat things, or rising TV volume has one more reason to take those signs seriously rather than dismiss them as ordinary aging.

The findings also give patients a practical talking point at their next appointment. If bone treatment is on the table, its possible side benefit for hearing is a reasonable topic to raise, and anyone with osteoporosis can ask whether a hearing check makes sense as part of routine care.

A 34 Percent Higher Risk Makes Early, Accessible Hearing Checks Matter More

One quiet message of this study is that the group most at risk, adults over 65 with a chronic condition already demanding appointments and expenses, is exactly the group for whom hearing care most often slips down the priority list. That is the barrier newer FDA-OTC hearing aids were designed to lower: checking and helping your hearing no longer has to wait for another round of clinic visits.

Panda Air is one example of that approach. It is an earbud-style, self-fitting OTC hearing aid with 16-channel WDRC sound processing and multi-band adaptive noise reduction, and its optional app can run a frequency-specific hearing test through the aid itself and tune amplification to your results at home. The test is optional, and the device also works out of the box.

For someone balancing osteoporosis care, the practical details help too: a fast-charge case providing 60 hours of total use, a 5-year warranty, and a 45-day trial that starts when the product arrives. One caveat worth knowing: OTC hearing aids are approved for mild to moderate hearing loss, and severe or profound loss still benefits most from a clinical fitting. Learn more at pandahearing.com/products/panda-air.

Limitations of This Research

This was a retrospective study built on insurance records, so it can show association but not prove that osteoporosis causes hearing loss or that the drugs prevent it. Diagnoses came from claims data rather than hearing tests performed for the study, and factors such as noise exposure or smoking history were not fully captured. The population studied was Taiwanese, so results may differ elsewhere, and the reason denosumab's benefit appeared only in men remains unexplained. The abstract does not report funding sources or conflicts of interest.

Where This Leaves Us

Bone health and hearing health appear to travel together in later life, and this large national study strengthens that case while hinting that treating one may help protect the other. For older adults with osteoporosis, the takeaway is simple and actionable: keep up with bone care, and give your hearing the same routine attention you give your bones.

Hung SH, Huang CF, Hsu JC, Carey JJ, Griffith JF, Chan WP. Osteoporosis and Risk of Hearing Loss: Protective Effects of Zoledronic Acid and Denosumab in a Nationwide Cohort. Journal of the American Geriatrics Society. 2026. Retrieved from PubMed. https://doi.org/10.1111/jgs.70654