Serum per- and polyfluoroalkyl substances (PFAS) and bone mineral density in Norwegian adolescents: sex-specific associations and mixture effects

Jin Wang; Maria Averina; Sandra Huber; Guri Grimnes; Gunhild Øygard Fosse; Åshild Bjørnerem; Elin Kristin Evensen; Jonas Johansson; Ragnar Martin Joakimsen

doi:10.1016/j.envint.2026.110235

Serum per- and polyfluoroalkyl substances (PFAS) and bone mineral density in Norwegian adolescents: sex-specific associations and mixture effects

Environ Int. 2026 Apr:210:110235. doi: 10.1016/j.envint.2026.110235. Epub 2026 Apr 3.

Authors

Jin Wang¹, Maria Averina², Sandra Huber³, Guri Grimnes⁴, Gunhild Øygard Fosse⁵, Åshild Bjørnerem⁶, Elin Kristin Evensen⁷, Jonas Johansson⁸, Ragnar Martin Joakimsen⁹

Affiliations

¹ Department of Clinical Medicine, Faculty of Health Sciences, UiT-The Arctic University of Norway, 9019 Tromsø, Norway; Tromsø Endocrine Research Group, Department of Clinical Medicine, UiT-The Arctic University of Norway, 9019 Tromsø, Norway. Electronic address: jin.wang@uit.no.
² Tromsø Endocrine Research Group, Department of Clinical Medicine, UiT-The Arctic University of Norway, 9019 Tromsø, Norway; Department of Laboratory Medicine, University Hospital of North Norway, 9019 Tromsø, Norway. Electronic address: maria.averina@unn.no.
³ Department of Laboratory Medicine, University Hospital of North Norway, 9019 Tromsø, Norway. Electronic address: sandra.huber@unn.no.
⁴ Tromsø Endocrine Research Group, Department of Clinical Medicine, UiT-The Arctic University of Norway, 9019 Tromsø, Norway; Department of Medicine, University Hospital of North Norway, 9019 Tromsø, Norway. Electronic address: guri.grimnes@unn.no.
⁵ Department of Clinical Medicine, Faculty of Health Sciences, UiT-The Arctic University of Norway, 9019 Tromsø, Norway; Tromsø Endocrine Research Group, Department of Clinical Medicine, UiT-The Arctic University of Norway, 9019 Tromsø, Norway; Department of Laboratory Medicine, University Hospital of North Norway, 9019 Tromsø, Norway. Electronic address: Gunhild.Oygard.Fosse@unn.no.
⁶ Department of Clinical Medicine, Faculty of Health Sciences, UiT-The Arctic University of Norway, 9019 Tromsø, Norway; Department of Obstetrics and Gynecology, University Hospital of North Norway, 9038 Tromsø, Norway; Norwegian Research Centre for Women's Health, Oslo University Hospital, 0424 Oslo, Norway. Electronic address: ashild.bjornerem@uit.no.
⁷ Department of Health and Care Sciences, Faculty of Health Sciences, UiT-The Arctic University of Norway, 9019 Tromsø, Norway. Electronic address: elin.k.evensen@uit.no.
⁸ Department of Community Medicine, Faculty of Health Sciences, UiT-The Arctic University of Norway, 9019 Tromsø, Norway. Electronic address: jonas.johansson@uit.no.
⁹ Department of Clinical Medicine, Faculty of Health Sciences, UiT-The Arctic University of Norway, 9019 Tromsø, Norway; Tromsø Endocrine Research Group, Department of Clinical Medicine, UiT-The Arctic University of Norway, 9019 Tromsø, Norway; Department of Medicine, University Hospital of North Norway, 9019 Tromsø, Norway. Electronic address: Ragnar.Joakimsen@unn.no.

PMID: 41950633
DOI: 10.1016/j.envint.2026.110235

Abstract

Background: Adolescence is the critical period for the development of peak bone mass. Per- and polyfluoroalkyl substances (PFAS) are widespread endocrine disruptors that may disturb skeletal development, but evidence in Nordic adolescents is limited.

Objectives: To evaluate sex-specific associations between serum PFAS and areal bone mineral density (aBMD) Z-scores among Norwegian adolescents.

Methods: This cross-sectional study utilised data from Fit Futures 1 (2010-2011), a cohort of adolescents in Northern Norway. Eighteen serum PFAS were quantified, and aBMD Z-scores (femoral neck, total hip, total body) were calculated using dual-energy X-ray absorptiometry. We used multivariable linear regression and mixture analyses (quantile g-computation and Bayesian kernel machine regression) to estimate sex-specific associations.

Results: Among 889 participants (421 girls and 468 boys; mean age 16.2 years), eight PFAS had detection rates >70%. The sum of linear and branched perfluorooctane sulfonic acid (ΣPFOS) had the highest median concentration (6.23 ng/ml). Perfluorononanoic acid (PFNA) (β = -0.16 per doubling, 95% CI: -0.26, -0.06) and perfluorodecanoic acid (PFDA) (β = -0.15 per doubling, 95% CI: -0.24, -0.06) showed consistent inverse association with total body aBMD. Mixture analyses suggested modest inverse overall mixture estimates, but 95% confidence intervals crossed the null. Sex-stratified analyses suggested that estimates tended to be more negative in boys than in girls.

Conclusions: Higher concentrations of several PFAS, particularly PFNA and PFDA, were modestly associated with lower aBMD Z-scores in Norwegian adolescents, most consistently for total body aBMD. Evidence for mixture effects and sex-specific differences was limited, although inverse associations tended to be more pronounced in boys. Longitudinal studies are needed to clarify temporal relationships and long-term skeletal impacts.

Keywords: Adolescents; Bone mineral density; Mixture effect; Perfluoroalkyl substances; Population-based study.

MeSH terms

Absorptiometry, Photon
Adolescent
Alkanesulfonic Acids / blood
Bone Density* / drug effects
Cross-Sectional Studies
Endocrine Disruptors / blood
Environmental Exposure* / statistics & numerical data
Environmental Pollutants* / blood
Female
Fluorocarbons* / blood
Humans
Male
Norway
Sex Factors

Substances

Fluorocarbons
Environmental Pollutants
Endocrine Disruptors
Alkanesulfonic Acids