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Lin, J. ; Leung, J.* ; Yu, B.* ; Woo, J.* ; Kwok, T.* ; Ka-Lun Lau, K.*

Association of green space with bone mineral density change and incident fracture in elderly Hong Kong Chinese: Mr. OS and Ms. OS study.

Environ. Res. 201:111547 (2021)
Postprint DOI PMC
Open Access Green
Background: A large body of literature has reported positive effects of green space (GS) on various aspects of health and well-being, while no studies explore the role of GS in bone health. Objectives: The present study aimed to investigate the associations of GS with bone mineral density (BMD) change and incident fracture in a prospective cohort of elderly Hong Kong Chinese. Methods: Between 2001 and 2003, 3944 participants aged 65 years and older at baseline were recruited. GS (%) within 300-m and 500-m buffers were calculated for each participant based on the Normalized Difference Vegetation Index. BMD at whole body, lumbar spine, total hip, and femoral neck were assessed by dual energy X-ray absorptiometry at baseline and 3 follow-ups. Incident fracture cases were ascertained from the electronic database of Hospital Authority of Hong Kong. Linear mixed-effects models and Cox proportional hazards models were used to investigate the associations of GS with changes in BMD and incident fracture, respectively. Results: Greater GS within 300-m and 500-m buffers were associated with a slower increase in lumbar spine BMD over 14 years. After adjustment for potential confounders, β and 95% confidence intervals (CIs) of change in BMD across Q2-Q4 (quartiles of GS measured in a 300-m, compared with Q1) were −6.42 (−12.3, −0.59), −7.78 (−13.6, −1.97), and −7.83 (−13.7, −2.00) mg/cm3, respectively. GS was also positively associated with non-spinal fracture and major osteoporotic fracture incidence risks. Multivariable-adjusted hazard ratios (95%CIs) were 1.40 (1.09, 1.79; P-trend = 0.036) for non-spinal fracture and 1.53 (1.13, 2.07; P-trend = 0.010) for major osteoporotic fracture (Q4 compared with Q1 of GS measured in a 300-m buffer). Positive GS-fracture associations were also found for GS within a 500-m buffer. Conclusions: We found that those who lived near higher GS levels had a slower increase in lumbar spine BMD and had higher incident fracture risk.
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Publication type Article: Journal article
Document type Scientific Article
Corresponding Author
Keywords Bone Mineral Density ; Cohort Study ; Dual Energy X-ray Absorptiometry ; Fracture ; Green Space; Physical-activity; Air-pollution; Osteoporotic Fractures; Residential Greenness; Socioeconomic-status; Hip Fracture; Cohort; Mortality; Health; Risk
ISSN (print) / ISBN 0013-9351
e-ISSN 1096-0953
Journal Environmental Research
Quellenangaben Volume: 201, Issue: , Pages: , Article Number: 111547 Supplement: ,
Publisher Elsevier
Publishing Place San Diego, Calif.
Non-patent literature Publications
Reviewing status Peer reviewed
Institute(s) Institute of Epidemiology II (EPI2)
Grants China Scholarship Council (CSC)