Abstract：
Several studies have shown associations between cadmium (Cd) exposure and an increased risk of fractures. However, the size of the risk is still unclear and proper adjustment for smoking is a challenge. The aim of this study was to quantify the association between dietary cadmium measured in blood and fracture risk in the general Swedish population through a large population-based case-control study in never-smokers.
The study included 2113 incident cases with osteoporosis-related fractures and the same number of age- and sex-matched controls in never-smokers from the Swedish population-based Malmö Diet and Cancer study cohort. Cd in blood (B-Cd) was analyzed at baseline (1991-1996). Incident osteoporosis-related fractures (of the hip, distal radius, and proximal humerus) up to the year 2014 were identified using the National Patient Register. Associations between B-Cd and fractures were analyzed using logistic regression.
Median B-Cd was 0.22 μg/L (P25 = 0.16, P75 = 0.31) among 2103 cases and 0.21 (P25 = 0.15, P75 = 0.30) among 2105 controls. The risk of fracture was significantly increased (OR 1.58; 95 % confidence interval 1.08-2.31, per μg/L of B-Cd), after adjustment for age, sex, BMI, physical activity, and fiber consumption. In analyses by cadmium quartiles, the OR increased monotonically and was significant in the highest quartile of B-Cd (for B-Cd > 0.31 versus B-Cd < 0.15 μg/L; OR 1.21; 95 % confidence interval 1.01-1.45).
Even modestly increased blood cadmium in never-smokers is associated with increased risk of incident osteoporosis-related fractures.
The study included 2113 incident cases with osteoporosis-related fractures and the same number of age- and sex-matched controls in never-smokers from the Swedish population-based Malmö Diet and Cancer study cohort. Cd in blood (B-Cd) was analyzed at baseline (1991-1996). Incident osteoporosis-related fractures (of the hip, distal radius, and proximal humerus) up to the year 2014 were identified using the National Patient Register. Associations between B-Cd and fractures were analyzed using logistic regression.
Median B-Cd was 0.22 μg/L (P25 = 0.16, P75 = 0.31) among 2103 cases and 0.21 (P25 = 0.15, P75 = 0.30) among 2105 controls. The risk of fracture was significantly increased (OR 1.58; 95 % confidence interval 1.08-2.31, per μg/L of B-Cd), after adjustment for age, sex, BMI, physical activity, and fiber consumption. In analyses by cadmium quartiles, the OR increased monotonically and was significant in the highest quartile of B-Cd (for B-Cd > 0.31 versus B-Cd < 0.15 μg/L; OR 1.21; 95 % confidence interval 1.01-1.45).
Even modestly increased blood cadmium in never-smokers is associated with increased risk of incident osteoporosis-related fractures.
摘要：
背景：一些研究表明镉（Cd）暴露与骨折风险增加之间存在关联。然而,风险的大小仍不清楚，适当调整吸烟是一个挑战。这项研究的目的是通过一项针对从不吸烟者的大型基于人群的病例对照研究，量化瑞典普通人群中血液中测得的膳食镉与骨折风险之间的关系。
方法：该研究包括2113例骨质疏松症相关骨折的事件病例，以及相同数量的年龄和性别匹配的从不吸烟者，来自瑞典人群的马尔默饮食和癌症研究队列。在基线(1991-1996)分析血液中的Cd(B-Cd)。与骨质疏松相关的骨折（髋部，桡骨远端,和肱骨近端)直到2014年都是使用国家患者登记册确定的。采用logistic回归分析B-Cd与骨折的关系。
结果：在2103例中，B-Cd中位数为0.22μg/L（P25=0.16，P75=0.31），在2105例中为0.21（P25=0.15，P75=0.30）。骨折风险显著增加(OR1.58;95%置信区间1.08-2.31,每μg/LB-Cd),调整后的年龄，性别,BMI,身体活动,纤维消耗。在镉四分位数的分析中，OR单调增加，并且在B-Cd的最高四分位数中很显着（对于B-Cd>0.31和B-Cd<0.15μg/L；OR1.21；95％置信区间1.01-1.45）。
结论：即使不吸烟者的血镉水平略有升高，也会增加与骨质疏松相关的骨折发生率。
方法：该研究包括2113例骨质疏松症相关骨折的事件病例，以及相同数量的年龄和性别匹配的从不吸烟者，来自瑞典人群的马尔默饮食和癌症研究队列。在基线(1991-1996)分析血液中的Cd(B-Cd)。与骨质疏松相关的骨折（髋部，桡骨远端,和肱骨近端)直到2014年都是使用国家患者登记册确定的。采用logistic回归分析B-Cd与骨折的关系。
结果：在2103例中，B-Cd中位数为0.22μg/L（P25=0.16，P75=0.31），在2105例中为0.21（P25=0.15，P75=0.30）。骨折风险显著增加(OR1.58;95%置信区间1.08-2.31,每μg/LB-Cd),调整后的年龄，性别,BMI,身体活动,纤维消耗。在镉四分位数的分析中，OR单调增加，并且在B-Cd的最高四分位数中很显着（对于B-Cd>0.31和B-Cd<0.15μg/L；OR1.21；95％置信区间1.01-1.45）。
结论：即使不吸烟者的血镉水平略有升高，也会增加与骨质疏松相关的骨折发生率。
