Archives of Osteoporosis

, 12:34 | Cite as

Impact of air pollution on vitamin D deficiency and bone health in adolescents

  • Elham Feizabad
  • Arash Hossein-nezhad
  • Zhila Maghbooli
  • Majid Ramezani
  • Roxana Hashemian
  • Syamak Moattari
Original Article



The association between air pollution and bone health was evaluated in adolescents in the city of Tehran. This study is essentially ecological. Vitamin D deficiency among adolescents has been reported at higher rates in polluted areas than in non-polluted areas. Additionally, residence in polluted areas is associated with lower levels of bone alkaline phosphatase.


The aim of this study was to evaluate the association between ambient air pollution and bone turnover in adolescents and to compare the prevalence of vitamin D deficiency between polluted and non-polluted areas of Tehran.


This cross-sectional population-based study was conducted on 325 middle- and high-school students (both girls and boys) in Tehran in the winter. During the study period, detailed daily data on air pollution were obtained from archived data collected by Tehran Air Quality Control Company (AQCC). Serum levels of calcium, phosphorus, parathyroid hormone (PTH), bone-specific alkaline phosphatase, 25(OH) vitamin D, osteocalcin, cross-linked C-telopeptide (CTX), total protein, albumin, and creatinine were obtained from the study group.


Vitamin D deficiency was more prevalent in polluted areas than in non-polluted areas. After adjustment for age and sex, residence in the polluted area showed a statistically significant positive association with vitamin D deficiency and a statistically significant negative association with bone turnover. Interestingly, high calcium intake (>5000 mg/week) protects against the effects of air pollution on bone turnover.


Air pollution is a chief factor determining the amount of solar UVB that reaches the earth’s surface. Thus, atmospheric pollution may play a significant independent role in the development of vitamin D deficiency.


Vitamin D Air pollution Airborne particles Bone health Adolescents Calcium intake UVB AQI Bone turnover Supplementation NO2 PM2.5 



The authors would like to thank the Endocrinology and Metabolism Research Institute, Bio and Nano Laboratory, Tehran Air Quality Control Company, and Ministry of Education as well as all the school staff, students, and their parents who helped us in this project.

Compliance with ethical standards

This research was carried out in compliance with the Helsinki Declaration and approved by the ethics committee of the Institute of Endocrinology and Metabolism, Tehran University of Medical Sciences.


This work was supported by the Endocrinology and Metabolism Research Institute; grant number: EMRI-1390.

Conflicts of interest



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Copyright information

© International Osteoporosis Foundation and National Osteoporosis Foundation 2017

Authors and Affiliations

  • Elham Feizabad
    • 1
  • Arash Hossein-nezhad
    • 2
    • 3
  • Zhila Maghbooli
    • 3
  • Majid Ramezani
    • 3
  • Roxana Hashemian
    • 4
  • Syamak Moattari
    • 5
  1. 1.Department of Community Medicine, School of MedicineTehran University of Medical SciencesTehranIran
  2. 2.Department of Medicine, Section of Endocrinology, Nutrition and DiabetesBoston University School of MedicineBostonUSA
  3. 3.Endocrinology and Metabolism Clinical Sciences InstituteTehran University of Medical SciencesTehranIran
  4. 4.Boston University School of Dental MedicineBostonUSA
  5. 5.Health Science DepartmentWorcester State UniversityWorcesterUSA

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