The objective was to investigate the hypothesis that environmental exposure to cadmium may affect calcium metabolism in the population at large. The 1987 participants (965 men and 1022 women), from 20 to 80 years old, constituted a random sample of the population of four Belgian districts. The urinary excretion of cadmium, a measure of lifetime exposure, averaged 9-3 nmol/24 h in men (range 0 4-324 nmol/24 h) and 7-1 nmol/24 h (range 0-1-71 nmol/24 h) in women. Serum alkaline phosphatase activity and the urinary excretion of calcium correlated significantly and positively with urinary cadmium excretion in both men and women, and serum total calcium concentration negatively with urinary cadmium excretion in men only. The regression coefficients obtained after adjustment for significant covariates indicated that when urinary cadmium excretion increased twofold, serum alkaline phosphatase activity and urinary calcium excretion rose by 3-4% and 0 25 mmoll24 h respectively, whereas in men serum total calcium concentration fell by 6 umolIl.After adjustment for significant covariates the relation between serum total calcium concentration and urinary cadmium excretion was Cadmium interferes with the metabolism of vitamin D, calcium, and collagen, and its accumulation may lead to osteomalacia and osteoporosis.'2 These effects are usually considered to be late manifestations of severe cadmium poisoning, and have been seen in exposed workers and in malnourished subjects.'" The quantitative dose-response relation for the effects of cadmium on calcium and bone metabolism, however, remains presently unknown. The present report, part of a cross sectional study on the effects of cadmium on public health,"7 investigated whether environmental exposure to cadmium influences calcium metabolism in the population at large.
Methods
SUBJECTSAs described elsewhere,"7 the 2327 subjects (age range from 20 to 79) constituted a random sample of the population of four Belgian districts selected to provide a wide range of environmental exposure to cadmium. Subjects were excluded from the present analysis when not all relevant measurements were available (n = 248), when 24 hour urine samples were judged under or over collected by previously published criteria (n = 44),8 or when either occupational exposure to heavy metals (n = 41) or smoking habits (n = 7) could not be ascertained from a self administered questionnaire.