Air Pollution Exposure and Osteoporosis among Retired Workers with Chronic Obstructive Pulmonary Disease

Background: While effects of occupational and environmental air pollution exposure on inflammation-related cardiopulmonary impairment are well documented, the association linking long-term air pollution exposure and osteoporosis risk is still unclear. The aim of this study was to investigate effects of long-term air pollution exposure on the risk of osteoporosis in people with chronic obstructive pulmonary disease (COPD). Methods: We collected 70 retired workers’ data from the pulmonary outpatient unit of a medical center in Taiwan and air pollution data from the Taiwan Environmental Protection Administration. Associations of 1-year averaged criteria air pollutants [particulate matter with aerodynamic diameters <10 μm (PM10), ozone (O3), nitrogen dioxide (NO2), sulfur dioxide (SO2), and carbon monoxide (CO)] with the risk of osteoporosis were explored by generalized additive models. Effect modification by inhaled corticosteroids (ICS) usage was also assessed in the model. Results: After controlling for age, sex, body mass index, current smoking, drinking, ICS usage, six-minute walk distance, global initiative for chronic obstructive and smooth functions of interview date and yearly temperature, we observed that increased 1-year averaged NO2 was significantly associated with 45% higher odds of osteoporosis (odds ratio=1.451 [95% confidence interval=1.124 to 1.778]). Retired workers with ICS usage showed 44% higher odds of osteoporosis associated with increased NO2. Conclusions: The risk of developing osteoporosis among retired workers with COPD was positively associated with long-term exposure to 1-year averaged NO2. ICS usage can modify the effect of NO2 on osteoporosis risk.