Associations of cadmium exposure within heavy metal combinations with osteoporosis risk: an analysis of NHANES data (2013-2014 and 2017-2018).

BACKGROUND

Environmental pollution is widely acknowledged as a critical contributor to osteoporosis. Previous studies confirmed that heavy metal exposure is closely associated with decreased bone mineral density.

OBJECTIVE

This study aimed to evaluate the relationship between cadmium (Cd) and the incidence of osteoporosis, and to explore the mediating role of inflammatory response and oxidative stress in the relationship.

METHODS

We examined the relationship between blood Cd levels and osteoporosis risk using data from the National Health and Nutrition Examination Survey (NHANES) conducted in 2013-2014 and 2017-2018, employing three statistical methods to evaluate these associations. Mediation analysis was conducted to investigate how inflammation and oxidative stress mediate Cd exposure-induced osteoporosis.

RESULTS

Among the 1290 individuals included in this study, 79 (6.12%) were diagnosed with osteoporosis. Our logistic regression analysis revealed a positive correlation between log10 Cd concentration and osteoporosis risk. Furthermore, heavy metal combinations showed a positive correlation with osteoporosis risk, with Cd identified as the primary factor in the Weighted Quantile Sum (WQS) and Bayesian Kernel Machine Regression (BKMR) models. Additionally, inflammation and oxidative stress acted as mediators in the correlation between Cd exposure and osteoporosis risk, accounting for 10.10% (OR: 0.002, 0.3, P = 0.042) and 4.06% (OR: 0.003, 0.11, P = 0.018) of the effect, respectively.

CONCLUSION

Our findings suggest that excessive Cd exposure increases osteoporosis risk, with inflammation and oxidative stress as key mediators. These results highlight the need for targeted strategies to reduce Cd exposure and protect bone health.