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Low-Level Cadmium Exposure Is Associated with Decreased Bone Mineral Density and Increased Risk of Incident Fractures in Elderly Men: The MrOS Sweden Study.

Journal article
Authors Maria Wallin
Lars Barregård
Gerd Sällsten
Thomas Lundh
Magnus K Karlsson
Mattias Lorentzon
Claes Ohlsson
Dan Mellström
Published in Journal of bone and mineral research : the official journal of the American Society for Bone and Mineral Research
Volume 31
Issue 4
Pages 732-41
ISSN 1523-4681
Publication year 2016
Published at Institute of Medicine, School of Public Health and Community Medicine
Centre for Bone and Arthritis Research
Institute of Medicine, Department of Internal Medicine and Clinical Nutrition
Pages 732-41
Language en
Subject categories Endocrinology, Public Health, Global Health, Social Medicine and Epidemiology, Orthopedics


One risk factor for osteoporosis which has attracted increasing attention in recent years is exposure to cadmium. The aim of this study was to examine the associations between low-level cadmium exposure, from diet and smoking, and BMD and incident fractures in elderly men. The study population consisted of 936 men from the Swedish cohort of the MrOS study, aged 70-81 years at inclusion (year 2002-2004), with reliable data on cadmium in urine (U-Cd) analyzed using inductively coupled plasma mass spectrometry in baseline samples. The participants also answered a questionnaire on lifestyle factors and medical history. BMD was measured at baseline using DXA in the total body, hip, and lumbar spine. During the follow-up period (until 2013), all new fractures were registered by date and type. Associations between BMD and U-Cd were assessed using multiple linear regression, and associations between incident fractures and baseline U-Cd were analyzed using Cox regression. In both cases, a number of potential confounders and other risk factors (e.g. age, smoking, BMI, and physical activity) were included in the models. We found significant negative associations between U-Cd and BMD, with lower BMD (4-8%) for all sites in the fourth quartile of U-Cd, using the first quartile as the reference. In addition, we found positive associations between U-Cd and incident fractures, especially non-vertebral osteoporosis fractures in the fourth quartile of U-Cd, with hazard ratios of 1.8-3.3 in the various models. U-Cd as a continuous variable was significantly associated with non-vertebral osteoporosis fractures (adjusted hazard ratio 1.3-1.4 per µg Cd/g creatinine), also in never-smokers, but not with the other fracture groups (all fractures, hip fractures, vertebral fractures, and other fractures). Our results indicate that even relatively low cadmium exposure through diet and smoking increases the risk of low BMD and osteoporosis-related fractures in elderly men. This article is protected by copyright. All rights reserved.

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