Particulate Air Pollution and Osteoporosis: A Systematic Review

Abstract

Air pollution is associated with inflammation and oxidative stress, which predispose to several chronic diseases in human. Emerging evidence suggests that the severity and progression of osteoporosis are directly associated with inflammation induced by air pollutants like particulate matter (PM). This systematic review examined the relationship between PM and bone health or fractures. A comprehensive literature search was conducted from January until February 2021 using the PubMed, Scopus, Web of Science, Google Scholar and Cochrane Library databases. Human cross-sectional, cohort and case–control studies were considered. Of the 1500 papers identified, 14 articles were included based on the inclusion and exclusion criteria. The air pollution index investigated by most studies were PM 2.5 and PM 10 . Current studies demonstrated inconsistent associations between PM and osteoporosis risk or fractures, which may partly due to the heterogeneity in subjects’ characteristics, study design and analysis. In conclusion, there is an inconclusive relationship between osteoporosis risk and fracture and PM exposures which require further validation.

Air pollution and decreased bone mineral density among Women's Health Initiative participants

“…A recent meta-analysis reported inconsistent associations between PM exposure and osteoporosis risk or fractures but attributed it to heterogeneous study designs, participant characteristics, and analyses. 50 While air pollution studies are indeed heterogeneous, results from our studies are consistent and suggest that thousands of aging populations may be affected around the globe, particularly by gases like NO 2 that were not included in previous analyses of particulate matter.…”

Associations between Long-Term Air Pollution Exposure and Risk of Osteoporosis-Related Fracture in a Nationwide Cohort Study in South Korea

“…Moreover, SO 2 and resulting pollutants can travel large distances far from the emission sources affecting a large number of residents [ 35 ]. SO 2 is generally highly correlated with other air pollutants, especially NO 2 and PM, which were positively correlated with osteoporosis in previous studies [ 36 ]. During the study period, high SO 2 emission and SO 2 concentrations were consistently observed in four of our seven target cities (e.g., Daejeon, Ulsan, Incheon, Busan) in our study, which contain many fossil-fuel-burning plants located at seaports and industrial complexes [ 37 , 38 ].…”

Osteoporosis in Patients With Respiratory Diseases

“…Environmental pollution was an important factor causing the decline of respiratory system function and leading to osteoporosis. Environmental pollutants related to the development of osteoporosis mainly included the particles with diameter <2.5 μm (PM 2.5 ) and automobile exhaust ( Chen et al, 2015 ; Pang et al, 2021 ). Previous studies reported that decreased spinal bone mineral density could be observed after exposure to PM 2.5 ( Ranzani et al, 2020 ).…”

“…PM 2.5 was positively correlated with serum RANKL and the osteoclast precursor CD14 (+) CD16 (+) monocytes ( Saha et al, 2016 ). Additionally, PM 2.5 could induce the secretion of inflammatory cytokines such as TNF-α, IL-1β, and IL-6, all of which were stimulators of bone resorption ( Pang et al, 2021 ). Additionally, vitamin D was deficient with PM 2.5 exposure ( Afsar et al, 2019 ).…”