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Environ Health Perspect. 2019 Aug;127(8):87006. doi: 10.1289/EHP4918. Epub 2019 Aug 21.

Per- and Polyfluoroalkyl Substance Plasma Concentrations and Bone Mineral Density in Midchildhood: A Cross-Sectional Study (Project Viva, United States).

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Department of Environmental Health, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA.
Center for Outcomes Research and Evaluation, Maine Medical Center Research Institute, Portland, Maine, USA.
Division of Chronic Disease Research Across the Lifecourse, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts, USA.
Division of Laboratory Sciences, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
Department of Biostatistics, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA.
Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, Massachusetts, USA.
Center for Clinical & Translational Research, Maine Medical Center Research Institute, Portland, Maine, USA.
Center for Environmental Research and Children's Health (CERCH), School of Public Health, University of California, Berkeley, California, USA.
Pediatric Endocrinology and Diabetes, Maine Medical Center, Portland, Maine, USA.



Identifying factors that impair bone accrual during childhood is a critical step toward osteoporosis prevention. Exposure to per- and polyfluoroalkyl substances (PFASs) has been associated with lower bone mineral density, but data are limited, particularly in children.


We studied 576 children in Project Viva, a Boston-area cohort of mother/child pairs recruited prenatally from 1999 to 2002. We quantified plasma concentrations of several PFASs and measured areal bone mineral density (aBMD) by dual-energy X-ray absorptiometry (DXA) in midchildhood. We used linear regression to examine associations between plasma concentrations of individual PFASs and aBMD z-score. We used weighted quantile sum (WQS) regression to examine the association of the PFAS mixture with aBMD z-score. All models were adjusted for maternal age, education, annual household income, census tract median household income, and child age, sex, race/ethnicity, dairy intake, physical activity, and year of blood draw.


Children were [[Formula: see text]] [Formula: see text] of age. The highest PFAS plasma concentrations were of perfluorooctanesulfonic acid (PFOS) {median [interquartile range (IQR)]: 6.4 (5.6) ng/mL} and perfluorooctanoic acid (PFOA) [median (IQR): 4.4 (3.2) ng/mL]. Using linear regression, children with higher plasma concentrations of PFOA, PFOS, and perfluorodecanoate (PFDA) had lower aBMD z-scores [e.g., [Formula: see text]: [Formula: see text]; 95% confidence interval (CI): [Formula: see text], [Formula: see text] per doubling of PFOA]. The PFAS mixture was negatively associated with aBMD z-score ([Formula: see text]: [Formula: see text]; 95% CI: [Formula: see text], [Formula: see text] per IQR increment of the mixture index).


PFAS exposure may impair bone accrual in childhood and peak bone mass, an important determinant of lifelong skeletal health.

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