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Association between outdoor particulate air pollution and the risk of osteoporosis: a systematic review and meta-analysis

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Abstract

Air pollution is a major threat to global health, which is associated with several adverse health outcomes and increased mortality. Few studies have investigated the association between air pollution and osteoporosis, and their findings were inconclusive. Our objective is to determine whether exposure to outdoor air pollution is causally associated with risk of osteoporosis. A systematic literature search of PubMed, Web of Science, Embase, and Cochrane Library for publications up to December 2020 was conducted for studies reporting the association between air pollution and osteoporosis. Meta-analysis was performed to estimate the pooled effect size of air pollution on osteoporosis using the relative risk (RR) and 95% confidence intervals (95% CI). Quality assessment was conducted, and all statistical analyses were performed by RevMan 5.3 software. Our search identified 9 eligible studies involving 9,371,212 patients. Meta-analysis revealed that there was an increased risk of osteoporosis (total body BMD and hip fracture) as a result of exposure to air pollution including PM2.5 and NO2. However, no significant excess risk of osteoporosis was found regardless of PM10, NO, and O3. In spite of a few number of epidemiological studies selected in the present literature review, this study indicated that the increased exposure to air pollutants was positively associated with high risk of osteoporosis. Further cohort studies with large sample sizes are needed to investigate different constituents and the duration of exposure of air pollutants.

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References

  1. Black DM, Rosen CJ (2016) Postmenopausal osteoporosis. N Engl J Med 374(21):2096–2097

    PubMed  Google Scholar 

  2. Zhang J, Dennison E, Prieto-Alhambra D (2020) Osteoporosis epidemiology using international cohorts. Curr Opin Rheumatol 32(4):387–393

    Article  Google Scholar 

  3. Sozen T, Ozisik L, Basaran NC (2017) An overview and management of osteoporosis. Eur J Rheumatol 4(1):46–56

    Article  Google Scholar 

  4. Lewiecki EM, Chastek B, Sundquist K, Williams SA, Weiss RJ, Wang Y, Fitzpatrick LA, Curtis JR (2020) Osteoporotic fracture trends in a population of US managed care enrollees from 2007 to 2017. Osteoporos Int 31:1299–1304

    Article  CAS  Google Scholar 

  5. Dennison EM et al (2019) Fracture risk following intermission of osteoporosis therapy. Osteoporos Int 30(9):1733–1743

    Article  CAS  Google Scholar 

  6. Kim KH, Kabir E, Kabir S (2015) A review on the human health impact of airborne particulate matter. Environ Int 74:136–143

    Article  CAS  Google Scholar 

  7. GBD 2017 Risk Factor Collaborators (2018) Global, regional, and national comparative risk assessment of 84 behavioural, environmental and occupational, and metabolic risks or clusters of risks for 195 countries and territories, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet 392(10159):1923–1994

  8. Schraufnagel DE, Balmes JR, Cowl CT, de Matteis S, Jung SH, Mortimer K, Perez-Padilla R, Rice MB, Riojas-Rodriguez H, Sood A, Thurston GD, To T, Vanker A, Wuebbles DJ (2019) Air pollution and noncommunicable diseases: a review by the Forum of International Respiratory Societies’ Environmental Committee, Part 2: Air Pollution and Organ Systems. Chest 155(2):417–426

    Article  Google Scholar 

  9. Qiao D, Pan J, Chen G, Xiang H, Tu R, Zhang X, Dong X, Wang Y, Luo Z, Tian H, Mao Z, Huo W, Zhang G, Li S, Guo Y, Wang C (2020) Long-term exposure to air pollution might increase prevalence of osteoporosis in Chinese rural population. Environ Res 183:109264

    Article  CAS  Google Scholar 

  10. Sung JH et al (2020) Association of air pollution with osteoporotic fracture risk among women over 50 years of age. J Bone Miner Metab

  11. Ranzani OT, Milà C, Kulkarni B, Kinra S, Tonne C (2020) Association of ambient and household air pollution with bone mineral content among adults in peri-urban South India. JAMA Netw Open 3(1):e1918504

    Article  Google Scholar 

  12. Prada D, Zhong J, Colicino E, Zanobetti A, Schwartz J, Dagincourt N, Fang SC, Kloog I, Zmuda JM, Holick M, Herrera LA, Hou L, Dominici F, Bartali B, Baccarelli AA (2017) Association of air particulate pollution with bone loss over time and bone fracture risk: analysis of data from two independent studies. Lancet Planet Health 1(8):e337–e347

    Article  Google Scholar 

  13. Chang KH, Chang MY, Muo CH, Wu TN, Hwang BF, Chen CY, Lin TH, Kao CH (2015) Exposure to air pollution increases the risk of osteoporosis: a nationwide longitudinal study. Medicine (Baltimore) 94(17):e733

    Article  CAS  Google Scholar 

  14. Alvaer K et al (2007) Outdoor air pollution and bone mineral density in elderly men - the Oslo Health Study. Osteoporos Int 18(12):1669–1674

    Article  CAS  Google Scholar 

  15. Alver K, Meyer HE, Falch JA, Søgaard AJ (2010) Outdoor air pollution, bone density and self-reported forearm fracture: the Oslo Health Study. Osteoporos Int 21(10):1751–1760

    Article  CAS  Google Scholar 

  16. Chen Z, Salam MT, Karim R, Toledo-Corral CM, Watanabe RM, Xiang AH, Buchanan TA, Habre R, Bastain TM, Lurmann F, Taher M, Wilson JP, Trigo E, Gilliland FD (2015) Living near a freeway is associated with lower bone mineral density among Mexican Americans. Osteoporos Int 26(6):1713–1721

    Article  CAS  Google Scholar 

  17. Mazzucchelli R, Crespi Villarias N, Perez Fernandez E, Durban Reguera ML, Garcia-Vadillo A, Quiros FJ, Guzon O, Rodriguez Caravaca G, Gil de Miguel A (2018) Short-term association between outdoor air pollution and osteoporotic hip fracture. Osteoporos Int 29(10):2231–2241

    Article  CAS  Google Scholar 

  18. Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gotzsche PC, Ioannidis JPA, Clarke M, Devereaux PJ, Kleijnen J, Moher D (2009) The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: explanation and elaboration. BMJ 339:b2700

    Article  Google Scholar 

  19. Yuan S, Wang J, Jiang Q, He Z, Huang Y, Li Z, Cai L, Cao S (2019) Long-term exposure to PM2.5 and stroke: a systematic review and meta-analysis of cohort studies. Environ Res 177:108587

    Article  CAS  Google Scholar 

  20. Balshem H, Helfand M, Schünemann HJ, Oxman AD, Kunz R, Brozek J, Vist GE, Falck-Ytter Y, Meerpohl J, Norris S, Guyatt GH (2011) GRADE guidelines: 3. Rating the quality of evidence. J Clin Epidemiol 64(4):401–406

    Article  Google Scholar 

  21. Hu CY, Fang Y, Li FL, Dong B, Hua XG, Jiang W, Zhang H, Lyu Y, Zhang XJ (2019) Association between ambient air pollution and Parkinson’s disease: systematic review and meta-analysis. Environ Res 168:448–459

    Article  CAS  Google Scholar 

  22. Nguyen TV (2017) Air pollution: a largely neglected risk factor for osteoporosis. Lancet Planet Health 1(8):e311–e312

    Article  Google Scholar 

  23. Araujo JA (2010) Particulate air pollution, systemic oxidative stress, inflammation, and atherosclerosis. Air Qual Atmos Health 4(1):79–93

    Article  Google Scholar 

  24. Pope CA 3rd et al (2016) Exposure to fine particulate air pollution is associated with endothelial injury and systemic inflammation. Circ Res 119(11):1204–1214

    Article  CAS  Google Scholar 

  25. Corcoran A, Cotter TG (2013) Redox regulation of protein kinases. FEBS J 280(9):1944–1965

    Article  CAS  Google Scholar 

  26. Solleiro-Villavicencio H, Rivas-Arancibia S (2018) Effect of chronic oxidative stress on neuroinflammatory response mediated by CD4(+)T cells in neurodegenerative diseases. Front Cell Neurosci 12:114

    Article  Google Scholar 

  27. Yang W, Omaye ST (2009) Air pollutants, oxidative stress and human health. Mutat Res 674(1-2):45–54

    Article  CAS  Google Scholar 

  28. Rahman I, MacNee W (1998) Role of transcription factors in inflammatory lung diseases. Thorax 53(7):601–612

    Article  CAS  Google Scholar 

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Funding

This work is supported by the Gansu Natural Science Foundation Youth Project (20JR10RA712), Gansu Province Endocrine Disease Clinical Medical Research Center (20JR10FA667), National Key Research and Development Program of China (2018YFC1313900, 2018YFC1313901), and the Special Funds of Science and Technology Development of the Chinese Central Government to guide Local in 2020 (an innovation platform for improving the prevention and treatment of frequently-occurring diseases in Gansu Province).

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  1. J. Liu and S. Fu contributed equally to this work.

Authors and Affiliations

  1. Department of Endocrinology, The First Hospital of Lanzhou University, No. 1 West Donggang Road, Lanzhou, Gansu, 730000, China

    JJ. Liu, SB. Fu & XL. Tang

  2. The First Clinical Medical College of Lanzhou University, No. 1 West Donggang Road, Lanzhou, Gansu, 730000, China

    J. Jiang

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  1. JJ. Liu
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Liu, J., Fu, S., Jiang, J. et al. Association between outdoor particulate air pollution and the risk of osteoporosis: a systematic review and meta-analysis. Osteoporos Int 32, 1911–1919 (2021). https://doi.org/10.1007/s00198-021-05961-z

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