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

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

Research output: Contribution to journalArticlepeer-review

8 Scopus citations


Background: Osteoporosis heavily affects postmenopausal women and is influenced by environmental exposures. Determining the impact of criteria air pollutants and their mixtures on bone mineral density (BMD) in postmenopausal women is an urgent priority. Methods: We conducted a prospective observational study using data from the ethnically diverse Women's Health Initiative Study (WHI) (enrollment, September 1994–December 1998; data analysis, January 2020 to August 2022). We used log-normal, ordinary kriging to estimate daily mean concentrations of PM10, NO, NO2, and SO2 at participants' geocoded addresses (1-, 3-, and 5-year averages before BMD assessments). We measured whole-body, total hip, femoral neck, and lumbar spine BMD at enrollment and follow-up (Y1, Y3, Y6) via dual-energy X-ray absorptiometry. We estimated associations using multivariable linear and linear mixed-effects models and mixture effects using Bayesian kernel machine regression (BKMR) models. Findings: In cross-sectional and longitudinal analyses, mean PM10, NO, NO2, and SO2 averaged over 1, 3, and 5 years before the visit were negatively associated with whole-body, total hip, femoral neck, and lumbar spine BMD. For example, lumbar spine BMD decreased 0.026 (95% CI: 0.016, 0.036) g/cm2/year per a 10% increase in 3-year mean NO2 concentration. BKMR suggested that nitrogen oxides exposure was inversely associated with whole-body and lumbar spine BMD. Interpretation: In this cohort study, higher levels of air pollutants were associated with bone damage, particularly on lumbar spine, among postmenopausal women. These findings highlight nitrogen oxides exposure as a leading contributor to bone loss in postmenopausal women, expanding previous findings of air pollution-related bone damage. Funding: US National Institutes of Health.

Original languageEnglish
Article number101864
StatePublished - Mar 2023
Externally publishedYes


  • Air pollution
  • Bone damage
  • Bone mineral density
  • Mixtures
  • Postmenopause


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