Osteoporosis International

, Volume 21, Issue 10, pp 1751–1760 | Cite as

Outdoor air pollution, bone density and self-reported forearm fracture: the Oslo Health Study

  • K. AlverEmail author
  • H. E. Meyer
  • J. A. Falch
  • A. J. Søgaard
Original Article



Air pollution is associated with several adverse health outcomes and increased mortality. In the Oslo Health Study, an association between long-term outdoor air pollution exposure and bone health was suggested in men aged 75/76 years, but not in younger men or in women.


Associations have been found between air pollution and a range of diseases, but few have studied whether bone health differs according to the concentration of air pollution. The aim of this study was to investigate the association between indicators of air pollution and bone health.


Self-reported forearm fracture was assessed in men and women 75/76 and 59/60 years (n = 5,976) participating in the Oslo Health Study 2000–2001. In subsamples of the participants (n = 1,039), we studied the relation between air pollution and forearm bone mineral density (BMD) measured by single X-ray absorptiometry. Exposure to air pollution (particulate matter (PM10 and PM2.5) and nitrogen dioxide (NO2)) at each participant’s home address was estimated from 1992 to 2001.


We found no associations between air pollution and self-reported forearm fractures or BMD in men aged 59/60 years or in women. In men aged 75/76 years, an increment of 10 units in PM2.5 was associated with a reduction in distal forearm BMD of 64 mg/cm2 (p < 0.05), and with an increased prevalence of forearm fracture after the age of 50 years among current smokers, OR = 7.4 (p < 0.05). Similar patterns of associations were suggested for PM10 and NO2.


In this study, bone health was not associated with long-term exposure to air pollution in women and in men 59/60 years of age. However, a negative association was suggested in elderly men. Further studies with improved measures of air pollution are warranted.


Air pollution Bone mineral density Epidemiology Forearm fracture Population study SXA 



The Osteoporosis sub-study was funded by the Norwegian Research Council and the data collection was carried out by the Norwegian Institute of Public Health as part of the Oslo Health Study 2000–2001. The Norwegian Osteoporosis Foundation supported the project on air pollution and bone health. Finally, we would like to thank Professor Per Nafstad, University of Oslo/Norwegian Institute of Public Health, and the Norwegian Institute for Air Research for providing data on air pollution exposure.

Conflicts of interest



  1. 1.
    Oftedal B, Brunekreef B, Nystad W, Madsen C, Walker SE, Nafstad P (2008) Residential outdoor air pollution and lung function in schoolchildren. Epidemiology 19:129–137CrossRefPubMedGoogle Scholar
  2. 2.
    World Health Organization (2005) Particulate matter air pollution: how it harms health. Fact sheet EURO/04/05, World Health Organisation Europe. Available via Accessed on 19 April 2009
  3. 3.
    Downs S, Forastiere F, Forsberg B, Hoek G (ed), Katsouyanni K (ed), Pekkanen J, Peters A, Raaschou-Nielsen O, Srám O, Sunyer J, Wichmann HE (2006) Air pollution and the risks to human health - Epidemiology. University of Maastricht, Netherlands. Available via Accessed 19 April 2009
  4. 4.
    Naess O, Nafstad P, Aamodt G, Claussen B, Rosland P (2007) Relation between concentration of air pollution and cause-specific mortality: four-year exposures to nitrogen dioxide and particulate matter pollutants in 470 neighbourhoods in Oslo, Norway. Am J Epidemiol 165:435–443CrossRefPubMedGoogle Scholar
  5. 5.
    World Health Organization (2002) The world health report 2002. Reducing risks, promoting healthy life. Available via Accessed 19 April 2009
  6. 6.
    Dockery DW, Pope CA III, Xu X, Spengler JD, Ware JH, Fay ME, Ferris BG Jr, Speizer FE (1993) An association between air pollution and mortality in six U.S. cities. N Engl J Med 329:1753–1759CrossRefPubMedGoogle Scholar
  7. 7.
    Pope CA III, Thun MJ, Namboodiri MM, Dockery DW, Evans JS, Speizer FE, Heath CW Jr (1995) Particulate air pollution as a predictor of mortality in a prospective study of U.S. adults. Am J Respir Crit Care Med 151:669–674PubMedGoogle Scholar
  8. 8.
    Pope CA III, Burnett RT, Thun MJ, Calle EE, Krewski D, Ito K, Thurston GD (2002) Lung cancer, cardiopulmonary mortality, and long-term exposure to fine particulate air pollution. JAMA 287:1132–1141CrossRefPubMedGoogle Scholar
  9. 9.
    McInnes H (2004) Calculations of air quality in Oslo for the years 1992 to 2002 (Norwegian). Norwegian Institute of Air Reseach, Technical report nr 8. Available via Accessed 19 April 2009
  10. 10.
    Slørdal LH, Mc Innes H, Krognes T (2008) The air quality information system AirQUIS. Info Tech Env Eng 1:40–47Google Scholar
  11. 11.
    Walker SE (2004) Calculation of NO2, PM10 and PM2.5 in Oslo for the HUBRO health study (Norwegian). Norwegian Institute for Air Research. Ordered report nr 75. Available via Accessed 29 Aug 2009
  12. 12.
    World Health Organization (2006) WHO Air quality guidelines for particulate matter, ozone, nitrogen dioxide and sulfur dioxide. Global update 2005. World Health Organization WHO/SDE/PHE/OEH/06.02 Available via Accessed 19 April 2009
  13. 13.
    Brook RD (2008) Cardiovascular effects of air pollution. Clin Sci (Lond) 115:175–187CrossRefGoogle Scholar
  14. 14.
    Basu S, Michaelsson K, Olofsson H, Johansson S, Melhus H (2001) Association between oxidative stress and bone mineral density. Biochem Biophys Res Commun 288:275–279CrossRefPubMedGoogle Scholar
  15. 15.
    Sanchez-Rodriguez MA, Ruiz-Ramos M, Correa-Munoz E, Mendoza-Nunez VM (2007) Oxidative stress as a risk factor for osteoporosis in elderly Mexicans as characterized by antioxidant enzymes. BMC Musculoskelet Disord 8:124CrossRefPubMedGoogle Scholar
  16. 16.
    Arron JR, Choi Y (2000) Bone versus immune system. Nature 408:535–536CrossRefPubMedGoogle Scholar
  17. 17.
    Lee SH, Kim TS, Choi Y, Lorenzo J (2008) Osteoimmunology: cytokines and the skeletal system. BMB Rep 41:495–510PubMedGoogle Scholar
  18. 18.
    Lorenzo J, Horowitz M, Choi Y (2008) Osteoimmunology: interactions of the bone and immune system. Endocr Rev 29:403–440CrossRefPubMedGoogle Scholar
  19. 19.
    Akesson A, Bjellerup P, Lundh T, Lidfeldt J, Nerbrand C, Samsioe G, Skerfving S, Vahter M (2006) Cadmium-induced effects on bone in a population-based study of women. Environ Health Perspect 114:830–834CrossRefPubMedGoogle Scholar
  20. 20.
    Alfven T, Elinder CG, Hellstrom L, Lagarde F, Jarup L (2004) Cadmium exposure and distal forearm fractures. J Bone Miner Res 19:900–905CrossRefPubMedGoogle Scholar
  21. 21.
    Bjora R, Falch JA, Staaland H, Nordsletten L, Gjengedal E (2001) Osteoporosis in the Norwegian moose. Bone 29:70–73CrossRefPubMedGoogle Scholar
  22. 22.
    Gruber HE, Gonick HC, Khalil-Manesh F, Sanchez TV, Motsinger S, Meyer M, Sharp CF (1997) Osteopenia induced by long-term, low- and high-level exposure of the adult rat to lead. Miner Electrolyte Metab 23:65–73PubMedGoogle Scholar
  23. 23.
    Hu H, Shih R, Rothenberg S, Schwartz BS (2007) The epidemiology of lead toxicity in adults: measuring dose and consideration of other methodologic issues. Environ Health Perspect 115:455–462CrossRefPubMedGoogle Scholar
  24. 24.
    Meyer HE, Berntsen GK, Sogaard AJ, Langhammer A, Schei B, Fonnebo V, Forsmo S, Tell GS (2004) Higher bone mineral density in rural compared with urban dwellers: the NOREPOS study. Am J Epidemiol 160:1039–1046CrossRefPubMedGoogle Scholar
  25. 25.
    Sanders KM, Nicholson GC, Ugoni AM, Seeman E, Pasco JA, Kotowicz MA (2002) Fracture rates lower in rural than urban communities: the Geelong Osteoporosis Study. J Epidemiol Community Health 56:466–470CrossRefPubMedGoogle Scholar
  26. 26.
    Sernbo I, Johnell O, Andersson T (1988) Differences in the incidence of hip fracture. Comparison of an urban and a rural population in southern Sweden. Acta Orthop Scand 59:382–385CrossRefPubMedGoogle Scholar
  27. 27.
    Søgaard AJ, Gustad TK, Bjertness E, Tell GS, Schei B, Emaus N, Meyer HE (2007) Urban-rural differences in distal forearm fractures: cohort Norway. Osteoporos Int 18:1063–1072CrossRefPubMedGoogle Scholar
  28. 28.
    Alvaer K, Meyer HE, Falch JA, Nafstad P, Sogaard AJ (2007) Outdoor air pollution and bone mineral density in elderly men—the Oslo Health Study. Osteoporos Int 18:1669–1674CrossRefPubMedGoogle Scholar
  29. 29.
    Sogaard AJ, Selmer R, Bjertness E, Thelle D (2004) The Oslo Health Study: The impact of self-selection in a large, population-based survey. Int J Equity Health 3:3CrossRefPubMedGoogle Scholar
  30. 30.
    Alver K, Meyer HE, Falch JA, Sogaard AJ (2005) Bone mineral density in ethnic Norwegians and Pakistani immigrants living in Oslo—the Oslo Health Study. Osteoporos Int 16:623–630CrossRefPubMedGoogle Scholar
  31. 31.
    Berntsen GK. Interpretation of forearm bone mineral density (2000) The Tromsø Study. Thesis. Institute of Community Medicine, University of Tromsø, NorwayGoogle Scholar
  32. 32.
    Berntsen GK, Tollan A, Magnus JH, Sogaard AJ, Ringberg T, Fonnebo V (1999) The Tromso Study: artifacts in forearm bone densitometry—prevalence and effect. Osteoporos Int 10:425–432CrossRefPubMedGoogle Scholar
  33. 33.
    Miljøverndepartementet (The Ministry of the Environment). Forskrift om begrensning av forurensning (Regulation of pollution control). 2004. Available via Accessed 29 Aug 2009
  34. 34.
    Oftedal B, Walker S, Gram F, McInnes H, Nafstad P (2009) Modelling long-term averages of local ambient air pollution in Oslo, Norway: evaluation of nitrogen dioxide, PM10 and PM2. Int J Environ Pollut 36:110–126CrossRefGoogle Scholar
  35. 35.
    Brennan SL, Pasco JA, Urquhart DM, Oldenburg B, Hanna F, Wluka AE (2008) The association between socioeconomic status and osteoporotic fracture in population-based adults: a systematic review. Osteoporos Int 20(9):1487–1497CrossRefPubMedGoogle Scholar
  36. 36.
    Ho SC, Chen YM, Woo JL (2005) Educational level and osteoporosis risk in postmenopausal Chinese women. Am J Epidemiol 161:680–690CrossRefPubMedGoogle Scholar
  37. 37.
    Meyer HE, Henriksen C, Falch JA, Pedersen JI, Tverdal A (1995) Risk factors for hip fracture in a high incidence area: a case-control study from Oslo, Norway. Osteoporos Int 5:239–246CrossRefPubMedGoogle Scholar
  38. 38.
    Wang MC, Dixon LB (2006) Socioeconomic influences on bone health in postmenopausal women: findings from NHANES III, 1988–1994. Osteoporos Int 17:91–98CrossRefPubMedGoogle Scholar
  39. 39.
    Rothman K, Greenland S (1998) Modern epidemiology. 2nd edn. Lippincott Williams & Wilkins. Philadephia, USA. pp 115-134Google Scholar
  40. 40.
    Geller AM, Zenick H (2005) Aging and the environment: a research framework. Environ Health Perspect 113:1257–1262CrossRefPubMedGoogle Scholar
  41. 41.
    Norwegian Institute for Air Research (2002) Nesten blyfri Oslo-luft. Norwegian Institute for Air Research. Available from: Accessed 19 April 2009
  42. 42.
    Campbell JR, Auinger P (2007) The association between blood lead levels and osteoporosis among adults–—results from the third national health and nutrition examination survey (NHANES III). Environ Health Perspect 115:1018–1022CrossRefPubMedGoogle Scholar
  43. 43.
    Sun Y, Sun D, Zhou Z, Zhu G, Zhang H, Chang X, Lei L, Jin T (2008) Osteoporosis in a Chinese population due to occupational exposure to lead. Am J Ind Med 51:436–442CrossRefPubMedGoogle Scholar
  44. 44.
    Vahter M, Akesson A, Liden C, Ceccatelli S, Berglund M (2007) Gender differences in the disposition and toxicity of metals. Environ Res 104:85–95CrossRefPubMedGoogle Scholar
  45. 45.
    Jarup L, Alfven T (2004) Low level cadmium exposure, renal and bone effects—the OSCAR study. Biometals 17:505–509CrossRefPubMedGoogle Scholar
  46. 46.
    Jarup L, Akesson A (2009) Current status of cadmium as an environmental health problem. Toxicol Appl Pharmacol 238:201–208CrossRefPubMedGoogle Scholar
  47. 47.
    Norwegian Institute of Public Health. Air pollution: Metals. 2009. Available via,3179:1:0:0:::0:0&MainLeft_5565=5544:52684::1:5569:1:::0:0 Accessed 29 Aug 2009
  48. 48.
    Baccarelli A, Zanobetti A, Martinelli I, Grillo P, Hou L, Lanzani G, Mannucci PM, Bertazzi PA, Schwartz J (2007) Air pollution, smoking, and plasma homocysteine. Environ Health Perspect 115:176–181CrossRefPubMedGoogle Scholar
  49. 49.
    Chen Z, Kooperberg C, Pettinger MB, Bassford T, Cauley JA, LaCroix AZ, Lewis CE, Kipersztok S, Borne C, Jackson RD (2004) Validity of self-report for fractures among a multiethnic cohort of postmenopausal women: results from the Women's Health Initiative observational study and clinical trials. Menopause 11:264–274CrossRefPubMedGoogle Scholar
  50. 50.
    Hundrup YA, Hoidrup S, Obel EB, Rasmussen NK (2004) The validity of self-reported fractures among Danish female nurses: comparison with fractures registered in the Danish National Hospital Register. Scand J Public Health 32:136–143CrossRefPubMedGoogle Scholar
  51. 51.
    Ivers RQ, Cumming RG, Mitchell P, Peduto AJ (2002) The accuracy of self-reported fractures in older people. J Clin Epidemiol 55:452–457CrossRefPubMedGoogle Scholar
  52. 52.
    Joakimsen RM, Fonnebo V, Sogaard AJ, Tollan A, Stormer J, Magnus JH (2001) The Tromso study: registration of fractures, how good are self-reports, a computerized radiographic register and a discharge register? Osteoporos Int 12:1001–1005CrossRefPubMedGoogle Scholar
  53. 53.
    Siris ES, Miller PD, Barrett-Connor E, Faulkner KG, Wehren LE, Abbott TA, Berger ML, Santora AC, Sherwood LM (2001) Identification and fracture outcomes of undiagnosed low bone mineral density in postmenopausal women: results from the National Osteoporosis Risk Assessment. JAMA 286:2815–2822CrossRefPubMedGoogle Scholar
  54. 54.
    Berntsen GKR, Fonnebo V, Tollan A, Sogaard AJ, Joakimsen RM, Magnus JH (2000) The Tromso study: determinants of precision in bone densitometry. J Clin Epidemiol 53:1104–1112CrossRefGoogle Scholar
  55. 55.
    Naess O, Piro FN, Nafstad P, Smith GD, Leyland AH (2007) Air pollution, social deprivation, and mortality: a multilevel cohort study. Epidemiology 18:686–694CrossRefPubMedGoogle Scholar

Copyright information

© International Osteoporosis Foundation and National Osteoporosis Foundation 2010

Authors and Affiliations

  • K. Alver
    • 1
    Email author
  • H. E. Meyer
    • 1
    • 2
  • J. A. Falch
    • 1
    • 3
  • A. J. Søgaard
    • 1
    • 2
  1. 1.Norwegian Institute of Public HealthOsloNorway
  2. 2.Institute of General Practice and Community Medicine, Faculty of MedicineUniversity of OsloOsloNorway
  3. 3.Center of Endocrinology, Faculty of MedicineUniversity of Oslo and Aker University Hospital HFOsloNorway

Personalised recommendations