title: 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.
  
  
  BACKGROUND
  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.
  
  
  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.
  
  
  CONCLUSIONS
  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 = 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 > or = 4 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.
authors.affiliation: Division of Environmental Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden. tobias.alfven@imm.ki.se
authors.forename: Tobias
authors.initials: T
authors.lastname: Alfvén
authors.forename: Carl-Gustaf
authors.initials: CG
authors.lastname: Elinder
authors.forename: Lennart
authors.initials: L
authors.lastname: Hellström
authors.forename: Frédéric
authors.initials: F
authors.lastname: Lagarde
authors.forename: Lars
authors.initials: L
authors.lastname: Järup
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001134:Arm Injuries / Q000139:chemically induced*; D002104:Cadmium / Q000633:toxicity*; D004781:Environmental Exposure; D005260:Female; D050723:Fractures, Bone / Q000139:chemically induced*; D006801:Humans; D007668:Kidney / Q000187:drug effects / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D011795:Surveys and Questionnaires
chemical_list: D002104:Cadmium