孕期和中年期全氟烷基和多氟烷基物质（PFAS）浓度与中年期骨骼健康的关联：生命项目的横断面和前瞻性研究结果
Associations of PFAS concentrations during pregnancy and midlife with bone health in midlife: Cross-sectional and prospective findings from Project Viva.
作者信息
Lin Pi-I Debby, Cardenas Andres, Rokoff Lisa B, Rifas-Shiman Sheryl L, Zhang Mingyu, Botelho Julianne, Calafat Antonia M, Gold Diane R, Zota Ami R, James-Todd Tamarra, Hauser Russ, Webster Thomas F, Oken Emily, Fleisch Abby F
机构信息
Division of Chronic Disease Research Across the Lifecourse, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA.
Department of Epidemiology and Population Health, Stanford University, Stanford, CA, USA.
出版信息
Environ Int. 2024 Dec;194:109177. doi: 10.1016/j.envint.2024.109177. Epub 2024 Dec 1.
BACKGROUND
PFAS may impair bone health, but effects of PFAS exposure assessed during pregnancy and the perimenopause-life stages marked by rapidly changing bone metabolism-on later life bone health are unknown.
METHODS
We studied 531 women in the Boston-area Project Viva cohort. We used multivariable linear, generalized additive, and mixture models to examine associations of plasma PFAS concentrations during early pregnancy [median (IQR) maternal age 32.9 (6.2) years] and midlife [age 51.2 (6.3)] with lumbar spine, total hip, and femoral neck areal bone mineral density (aBMD) and bone turnover biomarkersassessed in midlife. We examined effect modification by diet and physical activity measured at the time of PFAS exposure assessment and by menopausal status in midlife.
RESULTS
Participants had higher PFAS concentrations during pregnancy [1999-2000; e.g., PFOA median (IQR) 5.4 (3.8) ng/mL] than in midlife [2017-2021; e.g.
, PFOA: 1.5 (1.2) ng/mL]. Women with higher PFOA, PFOS and PFNA during pregnancy had higher midlife aBMD, especially of the spine [e.g., 0.28 (95% CI: 0.07, 0.48) higher spine aBMD T-score, per doubling of PFOA], with stronger associations observed among those with higher diet quality. In contrast, higher concentrations of all PFAS measured in midlife were associated with lower concurrent aBMD at all sites [e.g., -0.21 (-0.35, -0.07) lower spine aBMD T-score, per doubling of PFOA]; associations were stronger among those who were postmenopausal. The associations of several PFAS with bone resorption (loss) were also stronger among postmenopausal versus premenopausal women.
DISCUSSION
Plasma PFAS measured during pregnancy versus in midlife had different associations with midlife aBMD. We found an adverse association of PFAS measured in midlife with midlife aBMD, particularly among postmenopausal women. Future studies with longer follow-up are needed to elucidate the effect of PFAS on bone health during the peri- and postmenopausal years.
背景
全氟烷基和多氟烷基物质（PFAS）可能损害骨骼健康，但孕期以及围绝经期（以骨代谢快速变化为特征的生命阶段）接触PFAS对晚年骨骼健康的影响尚不清楚。
方法
我们对波士顿地区的“活力计划”队列中的531名女性进行了研究。我们使用多变量线性模型、广义相加模型和混合模型，来研究孕早期（母亲年龄中位数[四分位间距]为32.9[6.2]岁）和中年期（年龄51.2[6.3]岁）血浆PFAS浓度与中年期测量的腰椎、全髋和股骨颈面积骨密度（aBMD）以及骨转换生物标志物之间的关联。我们通过在PFAS暴露评估时测量的饮食和身体活动，以及中年期的绝经状态来检验效应修饰。
结果
参与者孕期的PFAS浓度[1999 - 2000年；例如，全氟辛酸（PFOA）中位数（四分位间距）为5.4（3.8）ng/mL]高于中年期[2017 - 2021年；例如，PFOA：1.5（1.2）ng/mL]。孕期PFOA、全氟辛烷磺酸（PFOS）和全氟萘酸（PFNA）水平较高的女性中年期的aBMD较高，尤其是脊柱[例如，PFOA每增加一倍，脊柱aBMD T值高0.28（95%置信区间：0.07，0.48）]，在饮食质量较高的人群中观察到更强的关联。相比之下，中年期测量的所有PFAS浓度较高与所有部位同时期的aBMD较低相关[例如，PFOA每增加一倍，脊柱aBMD T值低0.21（-0.35，-0.07）]；在绝经后女性中关联更强。绝经后女性与绝经前女性相比，几种PFAS与骨吸收（流失）的关联也更强。
讨论
孕期与中年期测量的血浆PFAS与中年期aBMD的关联不同。我们发现中年期测量的PFAS与中年期aBMD存在不良关联，尤其是在绝经后女性中。需要进行更长随访期的未来研究，以阐明PFAS在围绝经期和绝经后对骨骼健康的影响。
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