Environmental Contaminants and Osteoporosis-Related Outcomes: A Systematic Review and Meta-Analysis
Abstract
Environmental contaminants (ECs) may impair skeletal health through endocrine disruption, oxidative stress, inflammation, and altered mineral homeostasis. This systematic review and meta-analysis evaluated the associations between EC exposure and osteoporosis-related outcomes in adults. PubMed/MEDLINE, Scopus, and Web of Science were searched in April 2026 for English-language studies published from 2016 onward. Study selection followed PRISMA guidelines, while methodological quality was evaluated using the Joanna Briggs Institute (JBI) checklist and Newcastle-Ottawa Scale (NOS). Evaluated contaminant classes encompassed ambient air pollution (PM2.5, PM10, PM1, NO2, NOx, SO2, CO, O3), per- and polyfluoroalkyl substances (PFAS), heavy metals and trace elements (e.g., cadmium, lead), pesticides, polycyclic aromatic hydrocarbons (PAHs), phthalates, volatile organic compounds (VOCs), persistent organic pollutants (POPs, dioxins, PCBs), brominated flame retardants (BFRs), and water disinfection by-products. Random-effects meta-analyses using restricted maximum likelihood estimation were conducted when at least 3 studies were available. Forty-eight studies involving 4,510,868 participants were included. Air contaminants showed the most consistent associations with reduced bone mineral density (BMD) and osteoporosis, followed by selected PFAS and cadmium exposures. Evidence for pesticides, PAHs, phthalates, volatile organic compounds VOCs, POPs, flame retardants, and water…
How strong is the evidence?
Evidence Hub reads this as a meta-analysis, done in people. Its evidence level is 1 of 5 (Highest · pooled evidence). Pooled evidence from several studies sits at the top of the evidence pyramid. Reported size: 4,510,868 participants or records.
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