Bone · 2026
Long-term exposure to ambient air pollution and risk of non-traumatic osteonecrosis of the femoral head: A nationwide cohort study.
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Nguyen Duy Thang, Chen Chun-Ching, Lian Yu Zhi, Nguyen Nguyen Thai Bao, Kuo Yi-Jie, Chen Yu-Pin
Аннотация
INTRODUCTION: Non-traumatic osteonecrosis of the femoral head (ONFH) results from chronic ischemia and impaired bone remodeling, but whether long-term air pollution contributes to its development remains unclear. This study evaluated the association between chronic exposure to ambient air pollutants and the risk of ONFH in a nationwide cohort.
METHODS: We analyzed 585,334 adults from Taiwan's Longitudinal Health Insurance Database 2000, followed from 1993 to 2013. Ten-year cumulative exposures to sulfur dioxide (SO₂), carbon monoxide (CO), particulate matter ≤2.5 μm (PM₂.₅) and ≤ 10 μm (PM₁₀), nitrogen oxides (NOX, NO, NO₂), total hydrocarbons (THC), non-methane hydrocarbons (NMHC), and methane (CH₄) were estimated using residential postal codes linked to environmental monitoring data. Cox proportional-hazards models were applied to estimate adjusted hazard ratios (HRs) for incident ONFH, with Bonferroni correction applied in sensitivity analyses.
RESULTS: Prolonged exposure to all pollutants was significantly associated with higher ONFH incidence. Adjusted HRs (95% CI) per standard-deviation increase were: SO₂ 1.31 (1.23-1.39), CO 1.78 (1.69-1.86), PM₂.₅ 1.76 (1.63-1.90), PM₁₀ 1.44 (1.33-1.55), NOX 1.56 (1.47-1.65), NO 1.40 (1.32-1.48), NO₂ 1.59 (1.49-1.69), THC 1.64 (1.55-1.72), NMHC 1.18 (1.11-1.24), and CH₄ 2.15 (2.02-2.29). Tertile analyses demonstrated consistent dose-response trends, with highest-tertile associations remaining significant after Bonferroni correction.
CONCLUSIONS: Long-term exposure to multiple ambient pollutants is associated with an increased risk of non-traumatic ONFH. These findings highlight air pollution as a modifiable environmental determinant of musculoskeletal health and emphasize the need for continued efforts to improve air-quality standards.
METHODS: We analyzed 585,334 adults from Taiwan's Longitudinal Health Insurance Database 2000, followed from 1993 to 2013. Ten-year cumulative exposures to sulfur dioxide (SO₂), carbon monoxide (CO), particulate matter ≤2.5 μm (PM₂.₅) and ≤ 10 μm (PM₁₀), nitrogen oxides (NOX, NO, NO₂), total hydrocarbons (THC), non-methane hydrocarbons (NMHC), and methane (CH₄) were estimated using residential postal codes linked to environmental monitoring data. Cox proportional-hazards models were applied to estimate adjusted hazard ratios (HRs) for incident ONFH, with Bonferroni correction applied in sensitivity analyses.
RESULTS: Prolonged exposure to all pollutants was significantly associated with higher ONFH incidence. Adjusted HRs (95% CI) per standard-deviation increase were: SO₂ 1.31 (1.23-1.39), CO 1.78 (1.69-1.86), PM₂.₅ 1.76 (1.63-1.90), PM₁₀ 1.44 (1.33-1.55), NOX 1.56 (1.47-1.65), NO 1.40 (1.32-1.48), NO₂ 1.59 (1.49-1.69), THC 1.64 (1.55-1.72), NMHC 1.18 (1.11-1.24), and CH₄ 2.15 (2.02-2.29). Tertile analyses demonstrated consistent dose-response trends, with highest-tertile associations remaining significant after Bonferroni correction.
CONCLUSIONS: Long-term exposure to multiple ambient pollutants is associated with an increased risk of non-traumatic ONFH. These findings highlight air pollution as a modifiable environmental determinant of musculoskeletal health and emphasize the need for continued efforts to improve air-quality standards.