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Increased blood cadmium levels were not associated with increased fracture risk but with increased total mortality in women: the Malmo Diet and Cancer Study

Journal article
Authors L. Moberg
P. M. Nilsson
G. Samsioe
Gerd Sällsten
Lars Barregård
G. Engstrom
C. Borgfeldt
Published in Osteoporosis International
Volume 28
Issue 8
Pages 2401-2408
ISSN 0937-941X
Publication year 2017
Published at Institute of Medicine, Department of Public Health and Community Medicine, Section of Occupational and environmental medicine
Pages 2401-2408
Language en
Keywords Cadmium, Diabetes mellitus, Fracture risk, Gastric ulcer, Mortality, Women, population-based cohort, bone-mineral density, follow-up, exposure, adults, osteoporosis, mechanisms, impact, hip, Endocrinology & Metabolism
Subject categories Endocrinology and Diabetes


This study aimed to investigate if high levels of blood cadmium at baseline were associated with increased fracture risk during follow-up in middle-aged women. No increased fracture risk was observed during follow-up, but women with higher levels of cadmium had an increased overall mortality. Introduction Exposure to high levels of cadmium has been associated with an increased fracture risk. The aim was to investigate a perceived association between low levels of blood cadmium (B-Cd) at baseline and risk of first incident fracture. Methods From the population-based Malm Diet and Cancer Study Cardiovascular cohort, 2920 middle-aged women with available background questionnaire and B-Cd measurements were included. Women were divided into quartiles (Q) according to their cadmium levels (Cd-Q1 < 0.18 mu g/L, Cd-Q2 0.180.28 mu g/L, Cd-Q3 0.28-0.51 ae g/ L, and Cd-Q4 > 0.51 mu g/L). National registries were analysed for prospective risk of fractures or death. Associations between B-Cd and fracture risk were assessed by survival analysis (Cox regression analysis). Results In total, 998 first incident fractures occurred in women during a follow-up lasting 20.2 years (median) (12.5-21.2 years) (25th-75th percentile). Women in Cd-Q4 were more often current smokers than in Cd-Q1 78.4 vs. 3.3% (p < 0.001) and the number of cigarettes smoked per day correlated with B-Cd (r = 0.49; p < 0.001). The risk of fracture was not associated with baseline B-Cd in adjusted models. The hazard ratio (HR) Cd-Q4 vs. Cd-Q1 was 1.06 (95% confidence interval (CI) 0.89-1.27). In the multivariate Cox regression, independent variables for increased fracture risk were history of gastric ulcer and increasing age, whereas increasing body mass index (BMI) lowered fracture risk. Overall mortality was significantly higher for women with high B-Cd, HR 2.06 (95% CI 1.57-2.69). Conclusions Higher blood levels of cadmium did not increase fracture risk in middle-aged women but reduced overall survival.

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