Osteoporosis is a bone disease that develops when bone mineral density (BMD) and bone mass decrease. Patients with osteoporosis commonly present with increased bone fragility that causes pain and increases the risk of fracture. Globally, it is estimated that an osteoporosis fracture occurs every three seconds, with most cases occurring in women over 50 years old. Losing bone density and mass is a normal part of ageing, but postmenopausal women are particularly vulnerable due to the association between osteoporosis and estrogen deficiency. Estrogen is responsible for the regulation of bone metabolism: Without sufficient estrogen, the body will not promote the activity of osteoblasts and is therefore unable to generate new bone. So, when estrogen levels drop during menopause, the woman may lose BMD and be more susceptible to fractures. Although there are several risk factors for osteoporosis, recent studies have shown that exposure to air pollution also increases a person’s risk of osteoporosis by lowering BMD.
An observational study by Diddier Prada and colleagues, published in the journal of eClinicalMedicine, investigated the relationship between postmenopausal BMD and environmental exposure to air pollutants. A sample of BMD from 9,041 postmenopausal women was taken from the Woman’s Health Initiative (WHI), along with their exposure to long-term air pollution data. The estimated daily mean concentrations of PM10, NO, NO2, and SO2 at participants’ geocoded addresses were used to inform the levels of air pollution exposure.
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The results of the study by Prada and colleagues found that higher levels of air pollution were associated with reduced BMD, particularly along the lumbar spine. The study reported that nitrous oxide had the greatest impact on BMD, contributing to being a leading cause of osteoporosis in postmenopausal women. Nitrogen oxides are a group of air pollutants mainly formed by the combustion of fossil fuels, meaning that women living close to busy roads and in large urban areas are more vulnerable to postmenopausal osteoporosis because of nitrogen oxide exposure.
GlobalData epidemiologists currently forecast that the total prevalent cases of post-menopausal osteoporosis in the UK will increase from 1,200,000 cases in 2023 to 1,260,000 cases in 2027. Among the total prevalent cases in 2027, only 650,000 cases are anticipated to be formally diagnosed by a physician, which means that women with osteoporosis are often unaware of their fragility and leave it untreated prior to a more significant event, namely a fracture. Physicians promote the use of hormone replacement therapies (HRTs) as a mechanism to maintain estrogen levels throughout menopause and reduce osteoporosis risk. In addition to this, physicians recommend maintaining a healthy diet and exercise to prevent BMD. As the population continues to age and cases of osteoporosis inevitably increase, it is important that women in high-risk areas are aware of their vulnerability and are offered increased support, testing, and encouragement to use HRT therapy, to reduce the number of osteoporosis fractures that will occur.
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