ArticleEnvironmental health perspectives2016
Association of Perfluoroalkyl Substances, Bone Mineral Density, and Osteoporosis in the U.S. Population in NHANES 2009-2010.
Article in Environmental health perspectives, 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 69 papers, 1 of them a synthesis that pooled it.
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Who cites it
69 citing papers in PubMed, 1 synthesis or guideline pooled it, 162 citations in OpenAlex.
- Per- and Polyfluoroalkyl Substances (PFAS) in Integrated Crop-Livestock Systems: Environmental Exposure and Human Health Risks.International journal of environmental research and public health · 2021Pooled it
- PFAS:VDR interactions and immunotoxicity through disruption of monocyte differentiation.Archives of toxicology · 2026Article
- Sex-Specific Associations Between Per- and Polyfluoroalkyl Substances and the Risk of Type 2 Diabetes: The Role of Genetic Susceptibility and Lipid Metabolism.Environmental health perspectives · 2026Article
- Environmental Contaminants and Osteoporosis-Related Outcomes: A Systematic Review and Meta-Analysis.Toxics · 2026Review
- Effects of Perfluorobutane Sulfonate (PFBS) on Development and Bone Mineralization in Zebrafish Larvae.Journal of applied toxicology : JAT · 2026Article
- Article
- Glyphosate exposure, bone mineral density, osteoporosis, and fractures in the United States population.Journal of environmental health science & engineering · 2026Article
- Association between the dietary index for gut microbiota and fracture prevalence among women aged 50 years and older: a NHANES-based study with a preliminary exploratory pilot analysis.Frontiers in public health · 2026Article
- Per- and polyfluorinated substances (PFAS) promote osteoclastogenesis and bone loss through PPARα activation.Toxicology reports · 2025Article
- Caffeine, riboflavin and curcumin amended clays for PFAS binding.Computers & chemical engineering · 2025Article
- Review
- Associations between Per- and Polyfluoroalkyl Substances Exposures and Bone Mineral: A Systematic Review and Best Evidence Synthesis.Environment & health (Washington, D.C.) · 2025Article
- Association of serum alkaline phosphatase levels with bone mineral density, osteoporosis prevalence, and mortality in US adults with osteoporosis: evidence from NHANES 2005-2018.Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA · 2025Article
- CHIASMA: Advancing chemicals and materials safety and sustainability assessments through innovative integration of in vitro and in silico (new approach) methodologies.Computational and structural biotechnology journal · 2025Article
- Associations of PFAS concentrations during pregnancy and midlife with bone health in midlife: Cross-sectional and prospective findings from Project Viva.Environment international · 2024Article
- Sex-specific association of per- and polyfluoroalkyl substances (PFAS) exposure with vitamin D concentrations in older adults in the USA: an observational study.Environmental health : a global access science source · 2024Observational
- Mid-Childhood Plasma Concentrations of Per- and Polyfluoroalkyl Substances, Modifiable Lifestyle Factors, and Bone Mineral Density Through Late Adolescence.Environmental science & technology · 2024Article
- The long-chain polyfluorinated alkyl substance perfluorohexane sulfonate (PFHxS) promotes bone marrow adipogenesis.Toxicology and applied pharmacology · 2024Article
- Article
- Per- and polyfluoroalkyl substances (PFAS) in paired tap water and house dust from United States homes.Indoor environments · 2024Article
9 more citing papers are in PubMed but not listed here.
Corrections and comments
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Authors and funding
7 authors at 5 institutions in 1 country.
Funding
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.
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. CITATION: Khalil 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.
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