The Association Between Cadmium Exposure and Osteoporosis: A Longitudinal Study and Predictive Model in a Chinese Female Population

Abstract

Objective: The association between cadmium exposure and osteoporosis has been rarely reported in longitudinal studies. In this study, we investigated the association between osteoporosis and cadmium exposure and developed predictive models in women in a longitudinal cohort.Materials and Methods: In total, 488 women living in southeastern China were included at baseline (1998). Cadmium in blood (BCd) and urine (UCd) and also renal dysfunction biomarkers and bone mineral density (BMD) were determined both at baseline and follow-up. A total of 307 subjects were finally included after excluding subjects that did not have exposure or effect biomarkers. Osteoporosis was defined based on T score ≤ −2.5. Multiple linear regression and multivariate logistic analysis were used to show the association between baseline data and follow-up osteoporosis. Based on the identified associated factors, nomograms were developed to graphically calculate the individual risk of osteoporosis.Results: The baseline BMD in subjects with osteoporosis was significantly lower than that in subjects without osteoporosis (0.59 vs. 0.71 g/cm2, p < 0.05). The prevalence of low bone mass at baseline was higher in subjects with osteoporosis than in those without osteoporosis (23.5 vs. 7.2%, p = 0.001). Logistic regression analysis demonstrated that age [odds ratio (OR) = 1.21, 95% confidence interval (CI): 1.16–1.27], UCd (OR = 1.03, 95% CI: 1.002–1.06) and the presence of low BMD (OR = 3.84, 95% CI: 1.49–9.89) were independent risk factors for osteoporosis. For those subjects with normal baseline BMD, age, UCd, and baseline BMD were also independent risk factors for osteoporosis. The OR value was 1.16 (95% CI: 1.10–1.22) for age, 2.27 (95% CI: 1.03–4.99) for UCd > 10 μg/g creatinine, and 0.39 (95% CI: 0.21–0.72) for BMDbaseline. We developed two nomograms to predict the risk of osteoporosis. The area under the curve was 0.88 (95% CI: 0.84–0.92) for total population and was 0.88 (95% CI: 0.84–0.92) for subjects with normal baseline BMD, respectively.Conclusion: Baseline age, UCd, and BMD were associated with follow-up osteoporosis in women. Nomograms showed good performance in predicting the risk of osteoporosis.

Relationship between blood cadmium levels and bone mineral density in adults: a cross-sectional study

“…Another cross-sectional study conducted in the United States revealed a dose-dependent relationship between bone trabecular scores and blood cadmium in both males and females (p < 0.05 for both trends), and a substantial inverse relationship between bone trabecular scores and blood cadmium revealed this association (p < 0.05) ( 25 ). Furthermore, a follow-up study including 488 females in southeast China revealed a noteworthy correlation between urinary cadmium and osteoporosis in females ( 26 ). The results of a study in a population of postmenopausal women in Korea showed a strong association between the risk of osteoporosis and bone loss and blood cadmium levels ( 27 ).…”

Relationship of blood heavy metals and osteoporosis among the middle-aged and elderly adults: A secondary analysis from NHANES 2013 to 2014 and 2017 to 2018

“…Moreover, the smoking subgroup was first discussed, the results revealed that smoking did not affect the relationship between blood Cd and the prevalence of osteoporosis. Furthermore, a recent study involving 488 women showed no correlation between blood Cd and osteoporosis ( 33 ). The potential mechanisms underlying the relationship between Cd and osteoporosis have been explored, including impairing the viability, proliferative ability, and osteogenic differentiation of bone marrow mesenchymal stem cells (BMMSCs) through the NF-κB and P2X7-PI3K-AKT signaling pathways ( 14 , 34 ).…”

Effect of Cadmium on Oxidative Stress Indices and Vitamin D Concentrations in Children

“…A chronic cadmium exposure has also been associated with osteotoxicity in adults [ 44 ]. Moreover, researchers have demonstrated the alleviated risk of osteoporosis in individuals exposed to cadmium [ 46 ].…”