Bad break: Osteoporosis-related bone fractures linked to air pollution


November 9, 2017


Columbia University’s Mailman School
of Public Health


Exposure to air pollution is associated with
osteoporosis-related loss of bone mineral density and risk of bone fractures,
according to a new study.

Exposure to air pollution is associated with osteoporosis-related loss of
bone mineral density and risk of bone fractures, according to a new study by
researchers at Columbia University’s Mailman School of Public Health. Their
findings are published in The Lancet Planetary Health.

The researchers are the first to document high rates of hospital admissions
for bone fractures in communities with elevated levels of ambient particulate
matter (PM2.5), a component of air pollution, with risk of bone fracture
admissions greatest in low-income communities. The findings, from a study of
osteoporosis-related fracture hospital admissions among 9.2 million Medicare
enrollees in the Northeast/Mid-Atlantic between 2003-2010, suggest that even a
small increase in PM2.5 concentrations would lead to an increase in bone
fractures in older adults.

A concurrent analysis of eight years of follow-up among 692 middle-aged,
low-income adults in the Boston Area Community Health/Bone Survey cohort found
that participants living in areas with higher levels of PM2.5 and black carbon,
a component of air pollution from automotive emissions, had lower levels of
parathyroid hormone, a key calcium and bone-related hormone, and greater
decreases in bone mineral density than those exposed to lower levels of these

Osteoporosis, the most common reason for a broken bone among the elderly,
is a disease in which bones become brittle and weak as the body loses more bone
mass than it can rebuild. There are an estimated 2 million osteoporosis-related
bone fractures in the U.S. each year, resulting in as much as $20 billion in
annual direct health costs. Typically, no symptoms are present prior to a
break, which often happens spontaneously or from something as harmless as a
hug. In the year after an older adult has a bone fracture, risk for death
increases by as much as 20 percent, and only 40 percent of those who had
fractures regain their independence.

The researchers write that particulate matter, including PM2.5, is known to
cause systemic oxidative damage and inflammation, which they suggest, could
accelerate bone loss and increase risk of bone fractures in older individuals.
Smoking, which contains several particulate matter components, has been
consistently associated with bone damage.

“Decades of careful research has documented the health risks of air
pollution, from cardiovascular and respiratory diseases, to cancer, and
impaired cognition, and now osteoporosis,” says Andrea Baccarelli, MD, PhD,
chair of Environmental Health Sciences at the Mailman School and the study’s
senior author. “Among the many benefits of clean air, our research
suggests, are improved bone health and a way to prevent bone fractures.”

In two studies published earlier this year, Baccarelli, a world leader in
the science of epigenetics, reported that Vitamin B can diminish the effects of
air pollution-induced cardiovascular disease, as well as epigenetic damage to
DNA. It is unclear if the benefits of Vitamin B extend to bone loss. Even so,
he says, the best way to prevent air-pollution-related diseases is through
policies to improve air quality.

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Journal Reference:

Diddier Prada,
Jia Zhong, Elena Colicino, Antonella Zanobetti, Joel Schwartz, Nicholas
Dagincourt, Shona C Fang, Itai Kloog, Joseph M Zmuda, Michael Holick, Luis A
Herrera, Lifang Hou, Francesca Dominici, Benedetta Bartali, Andrea A
Baccarelli. Association of air particulate pollution with bone loss over
time and bone fracture risk: analysis of data from two independent studies
The Lancet Planetary Health, 2017; 1 (8): e337 DOI: 10.1016/S2542-5196(17)30136-5