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Per- and polyfluoroalkyl substances exposure and bone mineral density in the U.S. population from NHANES 2005–2014



Environmental exposures such as perfluoroalkyl substances (PFASs) were considered potential risks for bone mineral density (BMD).


To examine the associations between PFASs and BMD among the U.S. population.


This study included a total of 6416 participants from the National Health and Nutrition Examination Survey (NHANES 2005–2014). Multiple linear regression models were used to analyze the associations between serum PFASs and BMD and the coefficient β with 95% confidence intervals (95% CI) was calculated as the effect estimate. Covariates such as age, race, BMI, smoking, alcohol intake, milk intake, and physical activity were adjusted in these models. Additionally, gender and menopausal period were considered in further subgroup analyses.


Based on the combined data of NHANES 2005–2014, the effects from exposure to PFASs on BMD were found with gender and menopausal status differences. Positive associations were found in PFOA (β = 0.010; 95% CI: 0.003, 0.016), PFHxS (β = 0.007; 95% CI: 0.003, 0.012), and PFNA (β = 0.001; 95% CI: 0.001, 0.017) in total population. Negative associations for PFOA (β = −0.020; 95% CI: −0.029, −0.012), PFOS (β = −0.011; 95% CI: −0.028, −0.011), PFHxS (β = −0.019; 95% CI: −0.025, −0.013), PFDE (β = −0.010; 95% CI: −0.016, −0.005), and PFNA (β = −0.011; 95% CI: −0.021, −0.002) were found in women, while no significant association was found in men. In further subgroup analyses, women in pre-menopause status showed consistent negative associations.


PFASs exposure may be associated with BMD and gender and menopausal status confound the associations.

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Fig. 1
Fig. 2: Adjusted regression coefficients (95% CIs) for changes in total femur BMD relative to PFAS concentrations (NHANES 2013–2014).


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Special appreciation should be given to the NHANES team and the participants in it.


This study was supported by Natural Science Foundation of Zhejiang Province (LY20H170002).

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Authors and Affiliations



XZ: conceptualization, statistical analysis, methodology, manuscript development, funding acquisition; JYL: data analysis, manuscript review; WWD: data analysis, manuscript review; MLT: statistical analysis, methodology, manuscript revision; SGY: conceptualization, supervision, manuscript review.

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Correspondence to Meng-Ling Tang or Shi-Gui Yan.

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The authors declare no competing interests.

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The data in this article come from NHANES. No Ethics approval and consent to participate is needed.

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Zhao, X., Lin, JY., Dong, WW. et al. Per- and polyfluoroalkyl substances exposure and bone mineral density in the U.S. population from NHANES 2005–2014. J Expo Sci Environ Epidemiol (2022).

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  • Osteoporosis
  • Per- and polyfluoroalkyl substances
  • Bone mineral density
  • Menopausal status


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