Association of long-term exposure to ambient air pollution with osteoporosis among cancer survivors: Results from the Korea National Health and nutrition examination survey

Introduction: Recent studies suggest that ambient air pollution may contribute to osteoporosis; however, research focusing on populations with greater susceptibility is lacking. This study seeks to explore the association between air pollution and osteoporosis focusing on cancer survivors.

Materials and methods: We analyzed data from 8977 individuals (2245 cancer survivors, 6732 cancer-free population) obtained from the Korea National Health and Nutrition Examination Survey (KNHANES) during 2007-2009 and 2015-2021. Air pollution exposures to PM₁₀, PM_2.5, SO₂, NO₂, and CO were estimated using air quality models and satellite data. Moving average concentrations over 1-3 years prior to the survey were calculated. Logistic regression models adjusting for demographic and lifestyle factors were used to assess the association between air pollution and osteoporosis status. Analyses were stratified by cancer survivorship status and sex.

Results: Among cancer survivors, particularly female cancer survivors, higher long-term exposure to air pollutants was associated with greater odds of osteoporosis. Cancer survivors exposed to higher PM₁₀ over 1-, 2-, and 3-year periods had greater odds of osteoporosis (all p < 0.05). In female cancer survivors, 1-year exposure to PM_2.5 was associated with 25 % higher odds of osteoporosis (OR = 1.25, 95 % CI = 1.02-1.54), and NO₂ exposure showed a similar association (OR = 1.42; 95 % CI = 1.06-1.90). These associations were not observed in the individuals without cancer history.

Conclusion: The association between air pollution and osteoporosis was observed in cancer survivors, especially among female cancer survivors. Our findings emphasize the need for targeted interventions for at-risk populations such as cancer survivors.