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Farash Khayalo H, Bahlgerdi M, Habibi A, Yektay S. Air pollution as a silent driver of osteoporosis: A narrative review of vitamin D impairment and skeletal vulnerability in female populations. JRHMS 2024; 3 (4) :8-29
URL: http://jrhms.thums.ac.ir/article-1-126-en.html

The intensification of urban air pollution and the rising concentration of particulate matter have emerged as significant environmental barriers to vitamin D synthesis, posing increasing risks to women's skeletal health. Consequently, reliance on sunlight in metropolises is no longer sufficient to meet physiological requirements. This narrative review investigates the synergy between exposure to atmospheric pollutants (such as PM2.5 and NOx) and the concurrent prevalence of vitamin D deficiency and early-onset osteoporosis in women. A narrative search was conducted across international (PubMed, Scopus, Web of Science, Google Scholar) and national (SID, Magiran) databases for studies published until 2025. From an initial pool of 412 records, 27 high-quality studies were selected for final inclusion following a rigorous three-stage screening process based on title, abstract, and full-text evaluation. Literature analysis revealed that air pollutants, by absorbing UVB radiation, reduce serum 25(OH)D levels in pregnant and menopausal women by up to 18.8% and increase the risk of vitamin D deficiency by up to 3.5-fold. Beyond reducing vitamin D, particulate matter directly shifts the bone remodeling balance toward resorption by inducing oxidative stress and systemic inflammation, leading to a significant decrease in bone mineral density (BMD) in the spine and hip. The results indicate that air pollution is an independent risk factor for women's health. Health policy-making must focus on reducing traffic-related pollutants and revising vitamin D supplementation protocols in polluted regions to prevent debilitating fractures in the future.