Association of Perfluoroalkyl Substances, Bone Mineral Density, and Osteoporosis in the U.S. Population in NHANES 2009–2010

Abstract

BackgroundPerfluoroalkyl substances (PFASs), including perfluorooctanoic acid (PFOA), perfluorooctane sulfonic acid (PFOS), perfluorohexane sulfonic acid (PFHxS), and perfluorononanoic acid (PFNA), are detectable in the serum of 95% of the U.S. population.ObjectiveConsidering the role of PFASs as endocrine disruptors, we examined their relationships with bone health.MethodsThe association between serum PFAS concentration and bone mineral density at total femur (TFBMD), femoral neck (FNBMD), lumbar spine (LSBMD), and physician-diagnosed osteoporosis was assessed in 1,914 participants using data from the National Health and Nutritional Examination Survey 2009–2010.ResultsThe mean age of the participants was 43 years. Men had higher serum PFAS concentrations than women (p < 0.001) except for PFNA. In both sexes, serum PFOS concentrations were inversely associated with FNBMD (p < 0.05). In women, significant negative associations were observed for natural log (ln)–transformed PFOS exposure with TFBMD and FNBMD, and for ln-transformed PFOA exposure with TFBMD (p < 0.05). In postmenopausal women, serum PFOS was negatively associated with TFBMD and FNBMD, and PFNA was negatively associated with TFBMD, FNBMD, and LSBMD (all p < 0.05). With one log unit increase in serum PFOA, PFHxS, and PFNA, osteoporosis prevalence in women increased as follows: [adjusted odds ratios (aORs)] 1.84 (95% CI: 1.17, 2.905), 1.64 (95% CI: 1.14, 2.38), and 1.45 (95% CI: 1.02, 2.05), respectively. In women, the prevalence of osteoporosis was significantly higher in the highest versus the lowest quartiles of PFOA, PFHxS, and PFNA, with aORs of 2.59 (95% CI: 1.01, 6.67), 13.20 (95% CI: 2.72, 64.15), and 3.23 (95% CI: 1.44, 7.21), respectively, based on 77 cases in the study sample.ConclusionIn a representative sample of the U.S. adult population, serum PFAS concentrations were associated with lower bone mineral density, which varied according to the specific PFAS and bone site assessed. Most associations were limited to women. Osteoporosis in women was also associated with PFAS exposure, based on a small number of cases.CitationKhalil N, Chen A, Lee M, Czerwinski SA, Ebert JR, DeWitt JC, Kannan K. 2016. Association of perfluoroalkyl substances, bone mineral density, and osteoporosis in the U.S. population in NHANES 2009–2010. Environ Health Perspect 124:81–87; http://dx.doi.org/10.1289/ehp.1307909

Perfluoroalkyl substances (PFASs) in wastewater treatment plants and drinking water treatment plants: Removal efficiency and exposure risk

“…PFASs have an anionic functional group and nonpolar perfluoroalkyl chain and can repel both water and oil. Because of the high energy of the CeF covalent bond (approximately 466 kJ/mol), PFASs are extremely resistant to biological and chemical degradation and show various toxicological effects (Mattsson et al, 2015;Khalil et al, 2016). PFASs have been detected in water (Post et al, 2013;Pan et al, 2014a;Lorenzo et al, 2016), sediment (Naile et al, 2010;Zhao et al, 2013;Qi et al, 2016), sludge (Llorca et al, 2011;Armstrong et al, 2016), wildlife (Pan et al, 2014b;Letcher et al, 2015), and non-occupationally exposed humans throughout the world (Hansen et al, 2001;Buser and Scinicariello, 2016).…”

Exploratory analysis of the potential relationship between urinary molybdenum and bone mineral density among adult men and women from NHANES 2007–2010

“…These variables were selected a priori . With the exception of U-CR, which was necessary to account for variability in urine output (Barr et al, 2005), all other aforementioned variables are risk factors (or surrogates for them) for reduced BMD (Akesson et al, 2006; Burger et al 1998, Hannan et al, 2000; Hukkanen et al, 2005; Khalil et al, 2008, 2016; Pollack et al, 2013; Staessen et al, 1999; Tsai et al, 2015) and, consequently, were considered for inclusion in the fully-adjusted statistical models. For example, we considered cadmium, lead, and mercury as potential covariates as these metals have been linked to osteotoxicity (Akesson et al, 2006; Pollack et al, 2013; Staessen et al, 1999; Tsai et al, 2015).…”

“…While BMD was also calculated by CDC for several other regions of the femur and spine, FN-BMD and LS-BMD (L1–L4), in particular, are recommended for evaluating osteoporosis and low BMD (Khalil et al, 2016; Looker et al, 2012; NOF, 2014), which is why this analysis specifically focused on these regions of the body.…”

“…In particular, frequency of alcohol consumption during the previous year, and prevalence of regular milk drinking (defined by CDC as milk consumption at least 5 times/week) during one’s lifetime, including childhood, were selected as surrogates for alcohol and calcium consumption, respectively (Campbell and Auinger, 2007; Khalil et al, 2016). …”

“…The prevalence of moderate-intensity (e.g., brisk walking, bicycling, swimming, or golf) or vigorous-intensity (e.g., running or basketball) recreational activity was selected to characterize overall physical activity level among the participants (Khalil et al, 2016). …”