Arch Osteoporos. 2025 Nov 27;20(1):147. doi: 10.1007/s11657-025-01636-y.
ABSTRACT
Hip fracture poses a major public health burden in aging populations. The relationship between long-term air pollution exposure and hip fracture risk remains unclear. In our study, long-term exposure to PM2.5, PM10, and NO2 was associated with increased hip fracture risk, while ozone exposure showed a protective effect.
PURPOSE: This study aimed to evaluate the associations between major air pollutants and incident hip fracture in a nationwide Chinese cohort.
METHODS: We included 14,101 participants aged ≥ 45 years from the China Health and Retirement Longitudinal Study (2011-2020). Annual concentrations of PM2.5, PM10, O3, and NO2 were estimated using the CHAP dataset. Log-binomial regression models were applied to calculate relative risks (RRs) and 95% confidence intervals (CIs). Subgroup and sensitivity analyses were performed to assess the robustness and consistency of the findings.
RESULTS: During a 9-year follow-up, 474 participants (3.37%) experienced hip fracture. Each 10 µg/m3 increase in PM2.5 and PM10 concentrations was associated with a higher risk of hip fracture (PM2.5: RR 1.129, 95% CI 1.071-1.191; PM10: RR 1.052, 95% CI 1.024-1.081). In contrast, ozone exposure showed an inverse association (RR 0.518, 95% CI 0.458-0.585). No overall association was found for NO2, although an elevated risk was observed in the third exposure quartile (RR 1.302, 95% CI 1.012-1.675). Subgroup analyses indicated stronger PM2.5-related risks among participants with higher education levels, a more pronounced inverse association with ozone in adults aged < 60 years and current smokers, and greater NO2-related risk among non-smokers.
CONCLUSIONS: Long-term exposure to PM2.5 and PM10 increased hip fracture risk, while ozone exposure appeared protective. Moderate NO2 exposure may also affect bone fragility. These results highlight the need for pollutant-specific prevention strategies.
PMID:41307780 | DOI:10.1007/s11657-025-01636-y
