Association of air pollution with osteoporotic fracture risk among women over 50 years of age



Air particulate matter (PM) is an environmental exposure associated with oxidation and inflammation. Whether particulate matter is associated with risk of osteoporotic bone fracture is unclear. We investigated the association between exposure to PM and risk of bone fractures.

Materials and methods

We collected data of 44,602 participants living in three metropolitan cities in Republic of Korea from National Health Insurance Service database. We examined the association of 2 year averaged concentrations of PM and osteoporotic fracture over 4 years. Exposure to 2-year averaged air pollution [PM2.5 (< 2.5 μm in aerodynamic diameter), PM10 [< 10 μm in aerodynamic diameter], PM coarse (PM ranging from 2.5 μm to 10 μm)] concentrations were estimated from 2008 to 2009 in Air Korea data. The adjusted hazard ratios (aHRs) and 95% confidence intervals (CIs) for osteoporotic fractures were calculated using the multivariate Cox proportional hazards model.


After adjusting for age, household income, and Charlson Comorbidity Index, PM 2.5 in one pollutant model increased the risk of osteoporotic fractures, compared to the first quartile group (4th quartile group aHR = 1.13, 95% CI 1.02–1.24). Also, PM 2.5 increased the risk of spine and non-spine fractures compared to the first quartile group (4th quartile group aHR = 1.17, 95% CI 1.00–1.38, aHR = 1.16, 95% CI 1.01–1.33). We found no association between PM10/PM coarse and osteoporotic fractures.


We found that PM2.5 is a risk factor for osteoporotic bone fractures.

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Kyuwoong Kim received a scholarship from the BK21plus education programme from the National Research Foundation of Korea.

Author information




Study design: SKK, CSMP. Acquisition, analysis or interpretation of data: all authors. Statistical analysis: SKK. Drafting manuscript: S. Manuscript revision: all authors. All authors approved the final content of the manuscript. SMP had full access to all of the data in the study and takes responsibility for the integrity of the data analysis. K. Kim and Sung contributed equally.

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Correspondence to Sang Min Park.

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Sung, J.H., Kim, K., Cho, Y. et al. Association of air pollution with osteoporotic fracture risk among women over 50 years of age. J Bone Miner Metab (2020).

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  • Air particulate matter (PM)
  • Osteoporotic fracture
  • Long-term exposure
  • National Health Insurance Data (NHIS)