Prada Diddier, Zhong Jia, Colicino Elena, Zanobetti Antonella, Schwartz Joel, Dagincourt Nicholas, Fang Shona C, Kloog Itai, Zmuda Joseph M, Holick Michael, Herrera Luis A, Hou Lifang, Dominici Francesca, Bartali Benedetta, Baccarelli Andrea A
Department of Environmental Health, Harvard T.H. Chan School of Public Health, Harvard University, 665 Huntington Ave, Boston, MA, 02115, USA.
Unidad de Investigación Biomédica en Cáncer, Instituto Nacional de Cancerología - Instituto de Investigaciones Biomédicas, Universidad Nacional Autónoma de México, Mexico City, 14080, Mexico.
Lancet Planet Health. 2017 Nov;1(8):e337-e347. doi: 10.1016/S2542-5196(17)30136-5. Epub 2017 Nov 9.
Air particulate matter (PM) is a ubiquitous environmental exposure associated with oxidation, inflammation, and age-related chronic disease. Whether PM is associated with loss of bone mineral density (BMD) and risk of bone fractures is undetermined.
We conducted two complementary studies of: (i) long-term PM <2.5 μm (PM) levels and osteoporosis-related fracture hospital admissions among 9.2 million Medicare enrollees of the Northeast/Mid-Atlantic United States between 2003-2010; (ii) long-term black carbon [BC] and PM levels, serum calcium homeostasis biomarkers (parathyroid hormone, calcium, and 25-hydroxyvitamin D), and annualized BMD reduction over a 8-year follow-up of 692 middle-aged (46.7±12.3 yrs), low-income BACH/Bone cohort participants.
In the Medicare analysis, risk of bone fracture admissions at osteoporosis-related sites was greater in areas with higher PM levels (Risk ratio [RR] 1.041, 95% Confidence Interval [CI], 1.030, 1.051). This risk was particularly high among low-income communities (RR 1.076; 95% CI, 1.052, 1.100). In the longitudinal BACH/Bone study, baseline BC and PM levels were associated with lower serum PTH (Estimate for baseline one interquartile increase in 1-year average BC= -1.16, 95% CI -1.93, -0.38; Estimate for baseline one interquartile increase in 1-year average PM= -7.39; 95%CI -14.17, -0.61). BC level was associated with higher BMD loss over time at multiple anatomical sites, including femoral neck (-0.08%/year per one interquartile increase; 95% CI -0.14, -0.02%/year) and ultradistal radius (-0.06%/year per one interquartile increase; 95% CI -0.12, -0.01%/year).
Our results suggest that poor air quality is a modifiable risk factor for bone fractures and osteoporosis, especially in low-income communities.
空气颗粒物（PM）是一种普遍存在的环境暴露因素，与氧化、炎症及年龄相关的慢性疾病有关。PM是否与骨矿物质密度（BMD）降低及骨折风险相关尚不确定。
我们进行了两项互补性研究：（i）对2003年至2010年间美国东北部/大西洋中部地区920万医疗保险参保者的长期PM<2.5μm（细颗粒物）水平与骨质疏松相关骨折住院情况进行研究；（ii）对692名中年（46.7±12.3岁）、低收入的BACH/骨骼队列参与者进行为期8年的随访，研究长期黑碳[BC]和PM水平、血清钙稳态生物标志物（甲状旁腺激素、钙和25-羟基维生素D）以及BMD的年化降低情况。
在医疗保险分析中，PM水平较高地区骨质疏松相关部位的骨折住院风险更高（风险比[RR]1.041，95%置信区间[CI]，1.030，1.051）。这种风险在低收入社区尤为高（RR 1.076；95% CI，1.052，1.100）。在纵向BACH/骨骼研究中，基线BC和PM水平与较低的血清甲状旁腺激素相关（基线1年平均BC每增加一个四分位数间距的估计值=-1.16，95% CI -1.93，-0.38；基线1年平均PM每增加一个四分位数间距的估计值=-7.39；95% CI -14.17，-0.61）。BC水平与多个解剖部位随时间的较高BMD损失相关，包括股骨颈（每增加一个四分位数间距每年-0.08%；95% CI -0.14，-0.02%/年）和桡骨远端（每增加一个四分位数间距每年-0.06%；95% CI -0.12，-0.01%/年）。
我们的结果表明，空气质量差是骨折和骨质疏松的一个可改变的风险因素，尤其是在低收入社区。
