Air Pollution Speeds Bone Loss from Osteoporosis

Elevated levels of air pollutants are associated with bone damage among postmenopausal women, according to new research. The effects were most evident on the lumbar spine, with nitrous oxides twice as damaging to the area than seen with normal aging.

Previous studies on individual pollutants have suggested adverse effects on bone mineral density, osteoporosis risk, and fractures in older individuals.

The new study is the first to explore the connection between air pollution and bone mineral density specifically in postmenopausal women, and the first to explore the effects of air pollution mixtures on bone outcomes.

The researchers analyzed data collected through the Women’s Health Initiative study, an ethnically diverse cohort of 161,808 postmenopausal women.

They estimated air pollution (PM10, NO, NO2, and SO2) exposures based on participants’ home addresses.

They measured bone mineral density (BMD; whole-body, total hip, femoral neck, and lumbar spine) at enrollment at follow-up at year one, year three, and year six using dual-energy X-ray absorptiometry.

The magnitude of the effects of nitrogen oxides on lumbar spine BMD would amount to 1.22 percent annual reductions — nearly double the annual effects of age on any of the anatomical sites evaluated.

These effects are believed to happen through bone cell death by way of oxidative damage and other mechanisms.

“Our findings confirm that poor air quality may be a risk factor for bone loss, independent of socioeconomic or demographic factors. For the first time, we have evidence that nitrogen oxides, in particular, are a major contributor to bone damage and that the lumbar spine is one of the most susceptible sites of this damage,” says study first author Diddier Prada, MD, PhD.

“Improvements in air pollution exposure, particularly nitrogen oxides, will reduce bone damage in postmenopausal women, prevent bone fractures, and reduce the health cost burden associated with osteoporosis among postmenopausal women. Further efforts should focus on detecting those at higher risk of air pollution-related bone damage,” says lead author Andrea Baccarelli, MD, PhD, chair of the Department of Environmental Health Sciences at Columbia Mailman School of Public Health.


Diddier Prada, Carolyn J. Crandall, Allison Kupsco, Marianthi-Anna Kioumourtzoglou, James D. Stewart, Duanping Liao, Jeff D. Yanosky, Andrea Ramirez, Jean Wactawski-Wende, Yike Shen, Gary Miller, Iuliana Ionita-Laza, Eric A. Whitsel, Andrea A. Baccarelli. Air pollution and decreased bone mineral density among Women’s Health Initiative participants. eClinicalMedicine, 2023; 57: 101864 DOI: 10.1016/j.eclinm.2023.101864

Materials provided by Columbia University’s Mailman School of Public Health. Note: Content may be edited for style and length.

Columbia University’s Mailman School of Public Health. “Air pollution speeds bone loss from osteoporosis.” ScienceDaily. ScienceDaily, 21 February 2023. <>.

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