“Live as if you were to die tomorrow. Learn as if you were to live forever.”
― Mahatma Gandhi
Previously in this column the general effects of forever chemicals, a wide-ranging group of compounds containing perfluoroalkyl and polyfluoroalkyl substances (PFAs), was examined. A recent study revisited these effects in a group particularly susceptible to the insidious effects of long-lived chemical exposure: young adults.
This most recent study focused on the potential future state of bone health among young people, because bones play an important role in maintaining a healthy life in later years. Poor bone health or low bone density (osteoporosis) increases the risk of fractures, which can be devastating when they occur in larger bones like the hips. Postmenopausal women and those of Hispanic descent are particularly at risk.
- The study examined the impact of PFAs on longitudinal changes in bone density in 441 adolescents, drawn from the Study of Latino Adolescents at Risk of Type 2 Diabetes (SOLAR) cohort and the Southern California Children’s Health Study (CHS) cohort. Fifty-eight percent of the participants were Hispanic.
The Take-Away:
- This is an important study because long-term bone health begins in childhood, particularly during puberty when rapid bone accrual occurs.
- The higher the concentration of PFAs such as perfluorooctane sulfonic acid (PFOS) at baseline, the lower the bone accrual (and increased risk of osteoporosis) over time.
- These findings suggest an increased risk of osteoporosis and subsequent fractures later in life, particularly among postmenopausal women and those of Hispanic descent, for those with a higher childhood and adolescent exposure to PFAs.
The Caveat:
Current estimates place the US drug market for osteoporosis at approximately $4 billion for 2025, involving approximately 20 percent of all women aged 50 years and older. For older Americans, in the first five years post-fracture, a study found that approximately 26 percent of women and 37 percent of men died. If a repeat fracture occurred within the same timeframe, the mortality risk increased to 50 percent for women and 75 percent for men.[1] Among ethnic groups, Hispanics have the highest risk.[2]
Bone health is the result of a multifactorial process involving genetics, exercise, hormones, and nutrition as well as exposure to certain diseases, environmental exposures, and medications. Bridging environmental exposure and nutrition are substances like PFAs which are often found in the packaging of many common foods, particularly take-away foods and prepackaged snacks.
The exact mechanisms by which these risks are conferred remains unknown, but previous research has suggested that PFAs act as endocrine disruptors within the body. They have been associated with the down regulation – and thus lower levels – of testosterone, which is important in regulating bone formation and bone loss. PFAs may also directly disrupt osteoblasts, which are the cells responsible for bone formation. Regardless of the mechanism, because future bone health is predominantly determined during childhood and adolescence, it is crucial to identify risk factors during these periods of life. Early intervention can assist in preserving bone health at all ages and preventing morbidities due to low bone density in adulthood.
Previous research has found that several common PFAs were present in 97 to 100 percent of individuals screened in the United States.[3] A comprehensive approach to wellness requires paying attention to not only what we eat and where it comes from, but how it is packaged.
The Study:
Additional Resources:
Wright, N.C., Looker, A.C., Saag, K.G., Curtis, J.R., Delzell, E.S., Randall, S., Dawson-Hughes, B., 2014. The recent prevalence of osteoporosis and low bone mass in the femoral neck or lumbar spine. J. Bone Miner. Res. 29, 2520–2526. https://doi.org/10.1002/jbmr.2269.
Kato, K., Wong, L.-Y., Jia, L.T., Kuklenyik, Z., Calafat, A.M., 2011. Trends in exposure to polyfluoroalkyl chemicals in the U.S. Population: 1999-2008. Environ. Sci. Technol. 45, 8037–8045. Https://doi.org/10.1021/es1043613.
[1] (Bliuc, Nguyen, Nguyen, Eisman, & Center, 2013)
[2] (Wright, et al., 2014)
[3] (Kato, Wong, Jia, Kuklenyik, & Calafat,, 2011)
