Cadmium Exposure and Distal Forearm Fractures

Abstract

The aim of this study was to analyze the relationship between low-level cadmium exposure and distal forearm fractures. Altogether, 1021 men and women exposed to cadmium in Sweden were included. The study indicates that cadmium exposure is associated with increased risk of forearm fractures in people over the age of 50.Introduction: Very few studies have been performed on environmental risk factors for fractures. Cadmium is known to cause damage to the kidneys and in high doses to the bone. The aim of this study was to analyze the relationship between low-level cadmium exposure and distal forearm fractures. Materials and Methods: A total of 479 men and 542 women, 16 -81 years of age, that were environmentally or occupationally exposed to cadmium were examined in 1997. Cadmium in urine was used to estimate dose, and information about previous fractures and risk factors for fractures was obtained from questionnaires. Fractures were validated using medical records. The association between cadmium dose and risk of forearm fracture was evaluated using Cox proportional hazard regression analysis. Results and Conclusion:The mean urinary cadmium in the study population was 0.74 nmol cadmium/mmol creatinine (10% and 90% percentiles are 0.19 and 1.42, respectively). For fractures occurring after the age of 50 years (n ϭ 558, 32 forearm fractures), the fracture hazard ratio, adjusted for gender and other relevant co-variates, increased by 18% (95% CI, 1.0 -38%) per unit urinary cadmium (nmol cadmium/mmol creatinine). When subjects were grouped in exposure categories, the hazard ratio reached 3.5 (90% CI, 1.1, 11) in the group of subjects with urinary cadmium between 2 and 4 nmol/mmol creatinine and 8.8 (90% CI, 2.6, 30) in the group of subjects with Ն4 nmol/mmol creatinine. Associations between cadmium and fracture risk were absent before the age of 50. Cadmium exposure is associated with increased risk of forearm fractures in people over 50 years of age.

Long-term cadmium exposure and the association with bone mineral density and fractures in a population-based study among women

“…(4,12) Alfvé n and colleagues (12) found a relative risk of 1.18 (95% CI 1.01-1.37) for forearm fractures per 1 mg/g of cr increment in U-Cd in men and women. In the study by Staessen and colleagues, (4) the relative risks associated with doubled urinary cadmium were 1.73 (95% CI 1.16-2.57, p ¼ .007) for fractures in women and 1.60 (95% CI 0.94-2.72, p ¼ .08) for height loss in men.…”

“…Also, studies on fracture risk are sparse and limited to populations living in the vicinity of cadmium-emitting industries. (4,12) Furthermore, it is not known whether the association is independent of tobacco smoking.…”

Outdoor air pollution, bone density and self-reported forearm fracture: the Oslo Health Study

“…Cadmium has been associated with reduced bone mineral density and increased fracture rates, even at low levels of exposure [19,20,45]. Although cadmiumpolluted air may occur, the concentration in ambient air is rather low and the major sources of cadmium exposure are cigarette smoke and food [46,47].…”

“…Another cross-link might be heavy metals such as lead and cadmium, which might be constituents of polluted air. These metals have repeatedly been linked to osteoporosis [19][20][21][22][23].…”

Aktualisierung der Stoffmonographie Cadmium - Referenz- und Human-Biomonitoring(HBM)-Werte. Stellungnahme der Kommission "Human-Biomonitoring" des Umweltbundesamtes

“…Seither sind einige weitere epidemiologische Untersuchungen über den Zusammenhang zwischen Cadmiumexposition und Veränderungen der Knochensubstanz veröffentlicht worden [31,64,71,72,73,74,75,76,77,78,79,80]. Eine Über-sicht über die Ergebnisse dieser Studien findet sich jeweils in EFSA [1] und ATSDR [2].…”