Abstract
Air particulate matter (PM) is a ubiquitous environmental exposure associated with oxidation, inflammation, and age-related chronic disease. Whether PM is associated with loss of bone mineral density (BMD) and risk of bone fractures is undetermined. We conducted two complementary studies of: (i) long-term PM <2.5 μm (PM2.5) levels and osteoporosis-related fracture hospital admissions among 9.2 million Medicare enrollees of the Northeast/Mid-Atlantic United States between 2003-2010; (ii) long-term black carbon [BC] and PM2.5 levels, serum calcium homeostasis biomarkers (parathyroid hormone, calcium, and 25-hydroxyvitamin D), and annualized BMD reduction over a 8-year follow-up of 692 middle-aged (46.7±12.3 yrs), low-income BACH/Bone cohort participants. In the Medicare analysis, risk of bone fracture admissions at osteoporosis-related sites was greater in areas with higher PM2.5 levels (Risk ratio [RR] 1.041, 95% Confidence Interval [CI], 1.030, 1.051). This risk was particularly high among low-income communities (RR 1.076; 95% CI, 1.052, 1.100). In the longitudinal BACH/Bone study, baseline BC and PM2.5 levels were associated with lower serum PTH (Estimate for baseline one interquartile increase in 1-year average BC= -1.16, 95% CI -1.93, -0.38; Estimate for baseline one interquartile increase in 1-year average PM2.5= -7.39; 95%CI -14.17, -0.61). BC level was associated with higher BMD loss over time at multiple anatomical sites, including femoral neck (-0.08%/year per one interquartile increase; 95% CI -0.14, -0.02%/year) and ultradistal radius (-0.06%/year per one interquartile increase; 95% CI -0.12, -0.01%/year). Our results suggest that poor air quality is a modifiable risk factor for bone fractures and osteoporosis, especially in low-income communities.
Highlights
In the U.S, ~2.1 million osteoporosis-related bone fractures are reported each year, resulting in as much as $20.3 billion in annual direct health costs.[1]
An interquartile-range (4.18 μg/m3) increase in PM2.5 was associated with a 4.1 % higher rate of hospital admission for bone fracture (Table 1) in models adjusted for socio-demographic variables, geographic characteristics, obesity, number of days with freezing temperatures (
Using a regression spline to fit PM2.5 level in the multivariable-adjusted regression model, we confirmed that the relationship between PM2.5 and rates of bone fractures was nearly linear across the entire range of PM2.5 levels (3–22 μg/m3) (Figure 2)
Summary
In the U.S, ~2.1 million osteoporosis-related bone fractures are reported each year, resulting in as much as $20.3 billion in annual direct health costs.[1]. Ambient levels of particulate matter (PM) air pollution have been associated with increased morbidity, hospitalization, and mortality from cardiovascular[6,7,8] and respiratory diseases,[9,10] as well as with cancer[11,12] and impaired cognition.[13,14,15] PM causes systemic oxidative damage[16] and inflammation,[17] which may result in accelerated bone loss and increased risk of bone fractures in older individuals. Whether PM is associated with loss of bone mineral density (BMD) and risk of bone fractures is undetermined
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