Association of Ambient and Household Air Pollution With Bone Mineral Content Among Adults in Peri-urban South India

IMPORTANCE: Air pollution is a major threat to global health. Osteoporosis is responsible for a substantial burden of disease globally and is expected to increase in prevalence because of population aging. Few studies have investigated the association between air pollution and bone health, and their findings were inconclusive. OBJECTIVE: To quantify the association between ambient and household air pollution and bone mass in a sample of the general population in peri-urban India. DESIGN, SETTING, AND PARTICIPANTS: This was a population-based cross-sectional analysis of the Andhra Pradesh Children and Parents Study cohort, which recruited participants from 28 villages near Hyderabad, South India, during 2009 to 2012. Separate linear mixed models were fitted with nested random intercepts (household within villages) for each exposure-outcome pair and were sequentially adjusted for potential confounders. Data analysis was conducted between April 2019 and July 2019. EXPOSURES: Annual mean ambient particulate matter air pollution less than 2.5 µm in aerodynamic diameter (PM(2.5)) and black carbon (BC) levels at the residence estimated by land-use regression and self-reported use of biomass cooking fuel. MAIN OUTCOMES AND MEASURES: The primary outcome was bone mineral content (BMC) measured in grams, corrected by bone area at the lumbar spine and left hip, as measured by dual-energy x-ray absorptiometry. The secondary outcome was bone mineral density measured in grams per centimeters squared. RESULTS: A total of 3717 participants were analyzed (mean [SD] age, 35.7 [14.0] years; 1711 [46.0%] women). The annual mean (SD) PM(2.5) exposure was 32.8 (2.5) μg/m(3), and the annual mean (SD) BC exposure was 2.5 (0.2) μg/m(3); 57.8% of participants used biomass cooking fuels. In fully adjusted models, PM(2.5) was associated with lower BMC in the spine (mean difference, −0.57 g per 3 μg/m(3) increase in PM(2.5); 95% CI, −1.06 to −0.07 g per 3 μg/m(3) increase in PM(2.5)) and hip (mean difference, −0.13 g per 3 μg/m(3) increase in PM(2.5); 95% CI, −0.3 to 0.03 g per 3 μg/m(3) increase in PM(2.5)). After confounder adjustment, exposure to PM(2.5) was also associated with lower bone mineral density in the spine (mean difference, −0.011 g/cm(2) per 3 μg/m(3) increase in PM(2.5); 95% CI, −0.021 to 0 g/cm(2) per 3 μg/m(3) increase in PM(2.5)) and hip (mean difference, −0.004 g/cm(2 )per 3 μg/m(3) increase in PM(2.5); 95% CI, −0.008 to 0.001 g/cm(2) per 3 μg/m(3) increase in PM(2.5)). Exposure to BC was associated with lower BMC in the spine (mean difference, −1.13 g per 1 μg/m(3) increase in BC; 95% CI, −2.81 to 0.54 g per 1 μg/m(3) increase in BC) and hip (mean difference, −0.35 g per 1 μg/m(3) increase in BC; 95% CI, −0.96 to 0.25 g per 1 μg/m(3) increase in BC), although the confidence intervals were wider. There was no association between biomass fuel use and spine BMC (mean difference, 0.12 g; 95% CI, −0.45 to 0.68 g). CONCLUSIONS AND RELEVANCE: In a cross-sectional analysis of a population-based cohort, ambient air pollution was associated with lower BMC in a young adult population in a peri-urban area of South India.