Cadmium exposure may increase the risk of
osteoporosis. However, there is no quick method to get bone mineral density (BMD) unless dual-energy X-ray absorptiometry (DXA) examinations were performed. In the present study, we aimed to identify associated factors to
osteoporosis and fracture in a Chinese female population with
cadmium exposure and develop nomograms to predict the risk. A total of 488 women was included in this study.
Cadmium in blood (BCd) and urine (UCd) were determined as exposure
biomarkers. BMD was determined using single-photon absorptiometry. Urinary N-acetyl-β-d-
glucosaminidase (UNAG) and urinary
albumin (UALB) were determined as renal function
biomarkers.
Osteoporosis was defined if T-score < - 2.5. Multiple logistic regression showed that age, BCd, and menopausal status were independent risk factors for
osteoporosis. The odds (OR) value was 1.19 (95% confidence interval (CI): 1.14-1.25) for age, 1.05 (95% CI: 1.004-1.10) for BCd, and 4.75 (95% CI: 1.65-13.69) for menopausal status after adjusting with cofounders. Age and UCd were the independent risk factors for
bone fracture. Nomograms were developed based on the associated factors. Age was the main determinant for
osteoporosis or fracture. Receiver operating curve showed acceptable performance in predicting
osteoporosis (area under the curve (AUC) = 0.93, 95CI: 0.90-0.96) and fracture (AUC = 0.67, 95% CI: 0.58-0.75). Linear discriminant analysis (LDA) further showed that 88.9% of
osteoporosis and 68.4% of fractures were correctly classified. Our study develops nomograms that may be used to predict
cadmium-induced
osteoporosis or fracture if BMD data is not available.