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Association between traffic-related air pollution and osteoporotic fracture hospitalizations in inland and coastal areas: evidences from the central areas of two cities in Shandong Province, China

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Abstract

Summary

Our result showed that short-term exposure to traffic-related air pollutants (TRAPs) might increase the risk of hospitalizations for osteoporotic fractures. It was suggested that government should formulate emission reduction policies to protect the health of citizens.

Introduction

As the main source of urban air pollution in China, exhaust emissions of motor vehicles have been linked to adverse health outcomes, but evidence of the relationship between short-term exposure to TRAPs and osteoporotic fractures is still relatively rare.

Methods

In this study, a total of 5044 inpatients from an inland city (Jinan) and a coastal city (Qingdao), two cities with developed transportation in Shandong Province, were included. A generalized additive model (GAM) was used to investigate the association between TRAPs and hospitalizations for osteoporotic fractures. The stratified analyses were performed by gender and age.

Results

Positive associations between TRAPs and osteoporotic fracture hospitalizations were observed. We found that short-term exposure to TRAPs was associated with increased numbers of hospitalizations for osteoporotic fractures. PM2.5 and PM10 were statistically significant associated with hospitalizations for osteoporotic fractures at both single-day and multiday lag structures only in Qingdao, with the strongest associations at lag06 and lag07 [RR=1.0446(95%CI: 1.0018,1.0891) for PM2.5, RR=1.0328(95%CI: 1.0084,1.0578) for PM10]. For NO2 and CO, we found significant associations at lag4 in the single lag structure in Jinan [RR=1.0354 (95%CI: 1.0071, 1.0646) for NO2, RR=1.0014 (95%CI: 1.0002, 1.0025) for CO], while only CO at lag4 was significantly associated with hospitalizations for osteoporotic fractures in Qingdao [1.0038 (1.0012, 1.0063)]. Stratified analyses indicated that the associations were stronger in females and older individuals (65 + years).

Conclusion

This study implied that short-term exposure to TRAPs pollution was associated with an increased risk of hospitalizations for osteoporotic fractures. Female patients and patients aged 65 + years appeared to be more vulnerable to TRAPs, suggesting that poor air quality is a modifiable risk factor for osteoporotic fractures.

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References

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

    PubMed  Google Scholar 

  2. Cooper C, Campion G, Melton LJ 3rd (1992) Hip fractures in the elderly: a world-wide projection. Osteoporos Int 2(6):285–289

    CAS  PubMed  Google Scholar 

  3. Akkawi I, Zmerly H (2018) Osteoporosis: current concepts. Joints 6(2):122–127

    PubMed  PubMed Central  Google Scholar 

  4. Johnell O, Kanis JA (2006) An estimate of the worldwide prevalence and disability associated with osteoporotic fractures. Osteoporos Int 17(12):1726–1733

    CAS  PubMed  Google Scholar 

  5. Reginster JY, Burlet N (2006) Osteoporosis: a still increasing prevalence. Bone 38(2 Suppl 1):S4–S9

    PubMed  Google Scholar 

  6. Johnell O, Kanis J (2005) Epidemiology of osteoporotic fractures. Osteoporos Int 16(Suppl 2):S3–S7

    PubMed  Google Scholar 

  7. Kerschan-Schindl K et al (2012) Measuring quality of life with the German Osteoporosis Quality of Life Questionnaire in women with osteoporosis. Wien Klin Wochenschr 124(15-16):532–537

    PubMed  Google Scholar 

  8. Leibson CL et al (2002) Mortality, disability, and nursing home use for persons with and without hip fracture: a population-based study. J Am Geriatr Soc 50(10):1644–1650

    PubMed  Google Scholar 

  9. Cummings SR, Melton LJ (2002) Epidemiology and outcomes of osteoporotic fractures. Lancet 359(9319):1761–1767

    PubMed  Google Scholar 

  10. Tranah GJ et al (2008) Genetic variation in candidate osteoporosis genes, bone mineral density, and fracture risk: the study of osteoporotic fractures. Calcif Tissue Int 83(3):155–166

    CAS  PubMed  PubMed Central  Google Scholar 

  11. MacGregor A, Snieder H, Spector TD (2000) Genetic factors and osteoporotic fractures in elderly people. Twin data support genetic contribution to risk of fracture. BMJ 320(7250):1669–1670

    CAS  PubMed  PubMed Central  Google Scholar 

  12. Lock CA et al (2006) Lifestyle interventions to prevent osteoporotic fractures: a systematic review. Osteoporos Int 17(1):20–28

    PubMed  Google Scholar 

  13. Chiu YC et al (2021) Long-term exposure to fine particulate matter and osteoporotic fracture: a case-control study in Taiwan. Environ Res 196:110888

    CAS  PubMed  Google Scholar 

  14. Flicker L et al (1995) Bone density determinants in elderly women: a twin study. J Bone Miner Res 10(11):1607–1613

    CAS  PubMed  Google Scholar 

  15. Huang Q, Kung AJMG (2003) and Metabolism. Genetics of osteoporosis 128(30):1609

    Google Scholar 

  16. Mazzucchelli R et al (2018) Short-term association between outdoor air pollution and osteoporotic hip fracture. Osteoporos Int 29(10):2231–2241

    CAS  PubMed  Google Scholar 

  17. Fraenkel M et al (2017) Is the association between hip fractures and seasonality modified by influenza vaccination? An ecological study. Osteoporos Int 28(9):2611–2617

    CAS  PubMed  Google Scholar 

  18. Zhang F et al (2022) Long-term exposure to air pollution might decrease bone mineral density T-score and increase the prevalence of osteoporosis in Hubei province: evidence from China osteoporosis prevalence study. Osteoporos Int 33(11):2357–2368. https://doi.org/10.1007/s00198-022-06488-7

    Article  CAS  PubMed  Google Scholar 

  19. Chang KH et al (2015) Exposure to air pollution increases the risk of osteoporosis: a nationwide longitudinal study. Medicine 94(17):e733

    CAS  PubMed  PubMed Central  Google Scholar 

  20. Qiao D et al (2020) Long-term exposure to air pollution might increase prevalence of osteoporosis in Chinese rural population. Environ Res 183:109264

    CAS  PubMed  Google Scholar 

  21. Peng KT et al (2019) Particulate matter exposure aggravates osteoarthritis severity. Clin Sci 133(21):2171–2187

    CAS  Google Scholar 

  22. Prada D et al (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

    PubMed  PubMed Central  Google Scholar 

  23. Bai L et al (2018) Exposure to traffic-related air pollution and acute bronchitis in children: season and age as modifiers. J Epidemiol Community Health 72(5):426–433

    PubMed  Google Scholar 

  24. Wang YS, Chang LC, Chang FJ (2021) Explore regional PM2.5 features and compositions causing health effects in Taiwan. Environ Manag 67(1):176–191

    Google Scholar 

  25. Zhu L et al (2015) The impact of ambient temperature on childhood HFMD incidence in inland and coastal area: a two-city study in Shandong Province, China. Int J Environ Res Public Health 12(8):8691–8704

    CAS  PubMed  PubMed Central  Google Scholar 

  26. Hwang H, Lee JY (2022) Impacts of COVID-19 on air quality through traffic reduction. Int J Environ Res Public Health 19(3):1718. https://doi.org/10.3390/ijerph19031718

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  27. Zhu J et al (2020) Assessment of temperature-hand, foot, and mouth disease association and its variability across urban and rural populations in Wuxi, China: a distributed lag nonlinear analysis. Am J Trop Med Hyg 103(5):2091–2099

    PubMed  PubMed Central  Google Scholar 

  28. Hao J et al (2020) Impact of ambient temperature and relative humidity on the incidence of hand-foot-mouth disease in Wuhan, China. Int J Environ Res Public Health. 17(2):428. https://doi.org/10.3390/ijerph17020428

    Article  PubMed  PubMed Central  Google Scholar 

  29. Zhang F et al (2021) Acute effects of ambient air pollution on clinic visits of college students for upper respiratory tract infection in Wuhan. China Environ Sci Pollut Res Int 28(23):29820–29830

    CAS  PubMed  Google Scholar 

  30. 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

    CAS  PubMed  Google Scholar 

  31. Liu JJ et al (2021) Association between outdoor particulate air pollution and the risk of osteoporosis: a systematic review and meta-analysis. Osteoporos Int 32(10):1911–1919

    CAS  PubMed  Google Scholar 

  32. Alver K et al (2010) Outdoor air pollution, bone density and self-reported forearm fracture: the Oslo Health Study. Osteoporos Int 21(10):1751–1760

    CAS  PubMed  Google Scholar 

  33. Sung JH et al (2020) Association of air pollution with osteoporotic fracture risk among women over 50 years of age. J Bone Miner Metab 38(6):839–847

    CAS  PubMed  Google Scholar 

  34. Chen Z et al (2015) Living near a freeway is associated with lower bone mineral density among Mexican Americans. Osteoporos Int 26(6):1713–1721

    CAS  PubMed  PubMed Central  Google Scholar 

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

    PubMed  PubMed Central  Google Scholar 

  36. Ruckerl R et al (2007) Air pollution and inflammation (interleukin-6, C-reactive protein, fibrinogen) in myocardial infarction survivors. Environ Health Perspect 115(7):1072–1080

    PubMed  PubMed Central  Google Scholar 

  37. Nishimoto N, Kishimoto T (2006) Interleukin 6: from bench to bedside. Nat Clin Pract Rheumatol 2(11):619–626

    CAS  PubMed  Google Scholar 

  38. Manolagas SC (2000) Birth and death of bone cells: basic regulatory mechanisms and implications for the pathogenesis and treatment of osteoporosis. Endocr Rev 21(2):115–137

    CAS  PubMed  Google Scholar 

  39. Lorenzo J, Horowitz M, Choi Y (2008) Osteoimmunology: interactions of the bone and immune system. Endocr Rev 29(4):403–440

    CAS  PubMed  PubMed Central  Google Scholar 

  40. 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

    CAS  PubMed  PubMed Central  Google Scholar 

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

    CAS  PubMed  Google Scholar 

  42. Grassi F et al (2007) Oxidative stress causes bone loss in estrogen-deficient mice through enhanced bone marrow dendritic cell activation. Proc Natl Acad Sci U S A 104(38):15087–15092

    CAS  PubMed  PubMed Central  Google Scholar 

  43. Møller P, Loft S (2010) Oxidative damage to DNA and lipids as biomarkers of exposure to air pollution. Environ Health Perspect 118(8):1126–1136

    PubMed  PubMed Central  Google Scholar 

  44. Bhattoa HP et al (2004) Prevalence and seasonal variation of hypovitaminosis D and its relationship to bone metabolism in community dwelling postmenopausal Hungarian women. Osteoporos Int 15(6):447–451

    CAS  PubMed  Google Scholar 

  45. Nilsson BER, Westlin NEJCORR (1971) Bone density in athletes 77(77):179–182

    CAS  Google Scholar 

  46. Karlsson MK et al (2012) Inferior physical performance tests in 10,998 men in the MrOS study is associated with recurrent falls. 41(6):740–746

  47. Wang L et al (2022) Assessment of the association between prenatal exposure to multiple ambient pollutants and preterm birth: a prospective cohort study in Jinan, east China. Ecotoxicol Environ Saf 232:113297

    CAS  PubMed  Google Scholar 

  48. Oh TK, Song IA (2020) Exposure to air pollution and risk of hip fracture: a population-based cohort study with a 6-year follow-up in South Korea. J Occup Environ Med 62(12):1034–1039

    CAS  PubMed  Google Scholar 

  49. Lin YH et al (2020) Air pollutants interaction and gender difference on bone mineral density t-score in Taiwanese adults. Int J Environ Res Public Health 17(24):9165. https://doi.org/10.3390/ijerph17249165

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  50. Tularam H et al (2020) Harbor and intra-city drivers of air pollution: findings from a land use regression model, Durban, South Africa. Int J Environ Res Public Health. 17(15):5406. https://doi.org/10.3390/ijerph17155406

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  51. Tian L, Sun S (2017) Comparison of health impact of air pollution between china and other countries. In: Dong G-H (ed) ambient air pollution and health impact in China. Springer Singapore, Singapore, pp 215–232

    Google Scholar 

  52. Kim H et al (2017) Association of circulating dipeptidyl-peptidase 4 levels with osteoporotic fracture in postmenopausal women. Osteoporos Int 28(3):1099–1108

    CAS  PubMed  Google Scholar 

  53. Ng CA et al (2021) Feasibility, safety and effectiveness of a pilot 16-week home-based, impact exercise intervention in postmenopausal women with low bone mineral density. Osteoporos Int 32(5):893–905

    PubMed  Google Scholar 

  54. Management of Osteoporosis in Postmenopausal Women: The Position Statement of The North American Menopause Society, P (2021) Management of osteoporosis in postmenopausal women: the 2021 position statement of The North American Menopause Society. Menopause 28(9):973–997

    Google Scholar 

  55. Balmes JR (2019) Household air pollution from domestic combustion of solid fuels and health. J Allergy Clin Immunol 143(6):1979–1987

    CAS  PubMed  Google Scholar 

  56. Liu Y et al (2022) Short-term effects of indoor and outdoor air pollution on the lung cancer morbidity in Henan Province, Central China. Environ Geochem Health 44(8):2711–2731

    CAS  PubMed  Google Scholar 

  57. Li G et al (2022) Outdoor air pollution enhanced the association between indoor air pollution exposure and hypertension in rural areas of eastern China. Environ Sci Pollut Res Int 29(49):74909–74920

    CAS  PubMed  Google Scholar 

  58. Doolittle ML et al (2021) The role of senolytics in osteoporosis and other skeletal pathologies. Mech Ageing Dev 199:111565

    CAS  PubMed  PubMed Central  Google Scholar 

  59. Teissier T et al (2022) Crosstalk between senescent bone cells and the bone tissue microenvironment influences bone fragility during chronological age and in diabetes. Front Physiol 13:812157

    PubMed  PubMed Central  Google Scholar 

  60. Bitzas S et al (2022) Risk factors and impacts of slips, trips, and falls in janitorial populations: a literature review. Appl Ergon 102:103745

    PubMed  Google Scholar 

  61. Gong Z, Muzumdar RH (2012) Pancreatic function, type 2 diabetes, and metabolism in aging. Int J Endocrinol 2012:320482

    PubMed  PubMed Central  Google Scholar 

  62. Zhou X et al (2022) Association between sulfur dioxide and daily inpatient visits with respiratory diseases in Ganzhou, China: a time series study based on hospital data. Front Public Health 10:854922

    PubMed  PubMed Central  Google Scholar 

  63. Song J et al (2019) Acute effect of ambient air pollution on hospitalization in patients with hypertension: a time-series study in Shijiazhuang. China Ecotoxicol Environ Saf 170:286–292

    CAS  PubMed  Google Scholar 

  64. Duan R et al (2021) Association between short-term exposure to fine particulate pollution and outpatient visits for ulcerative colitis in Beijing, China: a time-series study. Ecotoxicol Environ Saf 214:112116

    CAS  PubMed  Google Scholar 

  65. Zhou CB et al (2022) More obvious association between short-term ambient nitrogen dioxide and atrial fibrillation outpatient visits in cool seasons: a hospital-based study in northwestern China. Environ Res 212(Pt B):113220

    CAS  PubMed  Google Scholar 

  66. Zhumalina AK et al (2020) Bone turnover markers in children and adolescents with environmentally determined short stature, living in the oil and gas processing region. Environ Sci Pollut Res Int 27(27):33998–34004

    PubMed  Google Scholar 

  67. Liu C et al (2015) Associations between ambient air pollution and bone turnover markers in 10-year old children: results from the GINIplus and LISAplus studies. Int J Hyg Environ Health 218(1):58–65

    CAS  PubMed  Google Scholar 

  68. Looker AC et al (1997) Prevalence of low femoral bone density in older U.S. adults from NHANES III. J Bone Miner Res 12(11):1761–1768

    CAS  PubMed  Google Scholar 

  69. Burge R et al (2007) Incidence and economic burden of osteoporosis-related fractures in the United States, 2005-2025. J Bone Miner Res 22(3):465–475

    PubMed  Google Scholar 

  70. Borgström F et al (2006) Costs and quality of life associated with osteoporosis-related fractures in Sweden. Osteoporos Int 17(5):637–650

    PubMed  Google Scholar 

  71. Zeng Q et al (2019) The prevalence of osteoporosis in China, a nationwide, multicenter DXA survey. J Bone Miner Res 34(10):1789–1797

    PubMed  Google Scholar 

  72. Cui Z et al (2019) Estimation and projection about the standardized prevalence of osteoporosis in mainland China. Arch Osteoporos 15(1):2

    PubMed  Google Scholar 

  73. WHO Guidelines Approved by the Guidelines Review Committee (2021) WHO global air quality guidelines: Particulate matter (PM(2.5) and PM(10)), ozone, nitrogen dioxide, sulfur dioxide and carbon monoxide. World Health Organization©World Health Organization, Geneva

    Google Scholar 

  74. Gao J et al (2023) Understanding the travel challenges and gaps for older adults during the COVID-19 outbreak: Insights from the New York City area. Transp Res Interdiscip Perspect 19:100815

    PubMed  PubMed Central  Google Scholar 

  75. Zeger SL et al (2000) Exposure measurement error in time-series studies of air pollution: concepts and consequences. Environ Health Perspect 108(5):419–426

    CAS  PubMed  PubMed Central  Google Scholar 

  76. Goldman GT et al (2011) Impact of exposure measurement error in air pollution epidemiology: effect of error type in time-series studies. Environ Health 10:61

    PubMed  PubMed Central  Google Scholar 

  77. Wu H et al (2020) Association of ambient PM(2·5) exposure with maternal bone strength in pregnant women from Mexico City: a longitudinal cohort study. Lancet Planet Health 4(11):e530–e537

    PubMed  PubMed Central  Google Scholar 

  78. Lu P et al (2020) Temporal trends of the association between ambient temperature and hospitalisations for cardiovascular diseases in Queensland, Australia from 1995 to 2016: a time-stratified case-crossover study. PLoS Med 17(7):e1003176

    PubMed  PubMed Central  Google Scholar 

  79. Kim KH et al (2013) Secondhand smoke exposure and osteoporosis in never-smoking postmenopausal women: the Fourth Korea National Health and Nutrition Examination Survey. Osteoporos Int 24(2):523–532

    CAS  PubMed  Google Scholar 

  80. Holmberg T et al (2011) Association between passive smoking in adulthood and phalangeal bone mineral density: results from the KRAM study--the Danish Health Examination Survey 2007-2008. Osteoporos Int 22(12):2989–2999

    CAS  PubMed  Google Scholar 

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Funding

This study was funded by grants from the Fundamental Research Funds for the Central Universities (204202021kf0044).

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Author notes

  1. Xupeng Zhang and Shengwen Yu are co-first authors who contributed equally to this paper.

Authors and Affiliations

  1. Department of Public Health, School of Public Health, Wuhan University, Wuhan, 430071, China

    Xupeng Zhang, Gaichan Zhao & Dejia Li

  2. Department of Orthopedics, Qingdao Hospital of Traditional Chinese Medicine (Qingdao Hiser hospital), Qingdao, 266033, China

    Shengwen Yu

  3. Department of Occupational and Environmental Health, School of Public Health, Wuhan University, Wuhan, 430071, China

    Faxue Zhang, Shijie Zhu, Xiaowei Zhang, Tianzhou Li, Wei Zhu & Dejia Li

  4. Department of Orthopedics, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, 250014, China

    Bo Yu

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Contributions

Dejia Li and Wei Zhu conceived and designed the study; Tianzhou Li and Bo Yu helped collect the data; Shijie Zhu, Gaichan Zhao, and Xiaowei Zhang cleaned the data; Xupeng Zhang performed the data analysis and drafted the manuscript. Shengwen Yu and Faxue Zhang helped revise the manuscript. All authors read and approved the final manuscript.

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Correspondence to Wei Zhu or Dejia Li.

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Zhang, X., Yu, S., Zhang, F. et al. Association between traffic-related air pollution and osteoporotic fracture hospitalizations in inland and coastal areas: evidences from the central areas of two cities in Shandong Province, China. Arch Osteoporos 18, 96 (2023). https://doi.org/10.1007/s11657-023-01308-9

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