Exposure to Multiple Air Pollutants and the Risk of Fractures: A Large Prospective Population‐Based Study.

This article investigates the association between long-term exposure to residential air pollution—specifically particulate matter (PM2.5, PM2.5–10, PM10) and nitrogen oxides (NO2 and NOx)—and the risk of incident fractures, using data from 446,395 UK Biobank participants. The study found that higher concentrations of fine particulate matter (PM2.5) and nitrogen oxides were significantly associated with increased fracture risk, with a 15.3% higher risk observed in participants exposed to the highest quintile of a composite air pollution score compared to the lowest. Serum 25-hydroxyvitamin D (25[OH]D) levels partially mediated these associations, accounting for approximately 4% to 6% of the effect, suggesting that air pollution may reduce vitamin D synthesis and thereby impact bone health. Stratified analyses indicated weaker associations among females, individuals with lower alcohol consumption, and those with higher fresh fruit intake. The study highlights air pollution as a modifiable environmental risk factor for fractures and underscores the potential role of vitamin D metabolism in this relationship.