Assessment of cadmium-induced osteopenia by measurement of serum bone Gla protein, parathyroid hormone, and 1 alpha,25-dihydroxyvitamin D

Parathyroid hormones in relation to serum cadmium and lead: the NHANES 2003-2006

The toxic effects of cadmium and lead exposure on parathyroid function have been investigated extensively while the results were conflicting. We aimed to investigate the association of blood cadmium and lead with serum parathyroid hormone (PTH) based on the general population. We analyzed a sample of 9400 adults aged 18 years or older from the US National Health and Nutrition Examination Survey 2003-2004 to 2005-2006. We estimated the association using multivariable linear regression analysis by taking cadmium and lead as a continuous or quartile variable. Restricted cubic splines were utilized to explore the non-linear relationship between cadmium or lead and PTH. The median blood cadmium and lead levels were 0.34 µg/L and 1.43 µg/dL, respectively. Cadmium was significantly associated with PTH when taken as a continuous variable [Odds ratio (OR): 0.97; 95% confidence interval (95% CI): 0.95-0.99] or a quartile variable (fourth vs first quartile, OR: 0.94; 95% CI: 0.91-0.97). Lead was significantly associated with PTH when taken as a continuous variable (OR: 1.04; 95% CI: 1.02-1.07) or a quartile variable (fourth vs first quartile, OR: 1.06; 95% CI: 1.01-1.10). P values for non-linearity were all less than 0.05. The association between cadmium and PTH was not significant in females. Cadmium was negatively associated with PTH, and lead was positively associated with PTH both in a non-linear manner among the general population. However, there was a gender difference in the relationship between cadmium and PTH.

Environmental Factors That Affect Parathyroid Hormone and Calcitonin Levels

Calciotropic hormones, parathyroid hormone (PTH) and calcitonin are involved in the regulation of bone mineral metabolism and maintenance of calcium and phosphate homeostasis in the body. Therefore, an understanding of environmental and genetic factors influencing PTH and calcitonin levels is crucial. Genetic factors are estimated to account for 60% of variations in PTH levels, while the genetic background of interindividual calcitonin variations has not yet been studied. In this review, we analyzed the literature discussing the influence of environmental factors (lifestyle factors and pollutants) on PTH and calcitonin levels. Among lifestyle factors, smoking, body mass index (BMI), diet, alcohol, and exercise were analyzed; among pollutants, heavy metals and chemicals were analyzed. Lifestyle factors that showed the clearest association with PTH levels were smoking, BMI, exercise, and micronutrients taken from the diet (vitamin D and calcium). Smoking, vitamin D, and calcium intake led to a decrease in PTH levels, while higher BMI and exercise led to an increase in PTH levels. In terms of pollutants, exposure to cadmium led to a decrease in PTH levels, while exposure to lead increased PTH levels. Several studies have investigated the effect of chemicals on PTH levels in humans. Compared to PTH studies, a smaller number of studies analyzed the influence of environmental factors on calcitonin levels, which gives great variability in results. Only a few studies have analyzed the influence of pollutants on calcitonin levels in humans. The lifestyle factor with the clearest relationship with calcitonin was smoking (smokers had increased calcitonin levels). Given the importance of PTH and calcitonin in maintaining calcium and phosphate homeostasis and bone mineral metabolism, additional studies on the influence of environmental factors that could affect PTH and calcitonin levels are crucial.

Gender-Specific Impact of Cadmium Exposure on Bone Metabolism in Older People Living in a Cadmium-Polluted Area in Thailand

To elucidate the influence of cadmium exposure on bone metabolism, associations between urinary/blood cadmium and bone resorption/formation markers were investigated in older cadmium exposed men and women. Increased urinary cross-linked N-telopeptide of type I collagen (NTx), a bone resorption marker, was found to be associated with increased levels of parathyroid hormone, fractional excretion of calcium, and urinary/blood cadmium after adjusting for confounding factors in men. In women, urinary NTx was significantly associated with only urinary cadmium and a strong relationship with increased fractional excretion of calcium. Risk for bone metabolic disorders, indicated by high urinary NTx, significantly increased in men with blood cadmium ≥ 10 μg/L or urinary cadmium ≥ 10 μg/g creatinine. Increased osteocalcin level was significantly associated with increased blood cadmium in men. In conclusion, cadmium exposure appeared to have an influence on bone remodeling both bone resorption and formation in this population of older Thai men, and blood cadmium was more closely associated with bone metabolism than urinary cadmium.

Chronic Cadmium Treatment Induces Tubular Nephropathy and Osteomalacic Osteopenia in Ovariectomized Cynomolgus Monkeys

In an attempt to establish a primate model of chronic cadmium toxicosis, we ovariectomized cynomolgus monkeys and treated them with CdCl2 by repeated intravenous injections for 13 to 15 months. The animals showed normocytic-normochromic anemia. The cadmium treatment resulted in increases of urinary enzyme activity indicative of renal tubular degeneration. Histopathology of the kidney revealed renal proximal tubular atrophy accompanied by interstitial fibrosis. Decreased bone mineral density was evident in the trabecular and cortical zones of the lumbar vertebra and femur, with osteoid accumulation around the trabeculae and Haversian canals. Iron deposition at the mineralization front and osteoclasts hyperplasia were indicative of impairment of bone mineralization and an increase of resorption. Blood inorganic phosphorus and 1α,25(OH)2 vitamin D3 levels decreased and urinary deoxypyridinoline level increased in cadmium-treated animals. The renal and bone lesions closely resemble those of itai-itai disease patients, the most severe case of cadmium toxicosis in terms of clinical chemistry and histopathology. Thus, ovariectomized monkeys chronically exposed to cadmium can serve as a primate itai-itai disease model, which is beneficial for developing novel therapeutic methods, investigating the mechanisms of the renal and bone lesions, and establishing more clearly defined criteria for diagnosing the disease.

Cadmium-induced bone effect is not mediated via low serum 1,25-dihydroxy vitamin D

Cadmium is a widespread environmental pollutant, which is associated with increased risk of osteoporosis. It has been proposed that cadmium's toxic effect on bone is exerted via impaired activation of vitamin D, secondary to the kidney effects. To test this, we assessed the association of cadmium-induced bone and kidney effects with serum 1,25-dihydroxyvitamin D (1,25(OH)(2)D); measured by enzyme immunoassay. For the assessment, we selected 85 postmenopausal women, based on low (0.14-0.39 microg/L) or high (0.66-2.1 microg/L) urinary cadmium, within a cross-sectional population-based women's health survey in Southern Sweden. We also measured 25-hydroxy vitamin D, cadmium in blood, bone mineral density and several markers of bone remodeling and kidney effects. Although there were clear differences in both kidney and bone effect markers between women with low and high cadmium exposure, the 1,25(OH)(2)D concentrations were not significantly different (median, 111 pmol/L (5-95th percentile, 67-170 pmol/L) in low- and 125 pmol/L (66-200 pmol/L) in high-cadmium groups; p=0.08). Also, there was no association between 1,25(OH)(2)D and markers of bone or kidney effects. It is concluded that the low levels of cadmium exposure present in the studied women, although high enough to be associated with lower bone mineral density and increased bone resorption, were not associated with lower serum concentrations of 1,25(OH)(2)D. Hence, decreased circulating levels of 1,25(OH)(2)D are unlikely to be the proposed link between cadmium-induced effects on kidney and bone.

Cadmium-induced effects on bone in a population-based study of women

High cadmium exposure is known to cause bone damage, but the association between low-level cadmium exposure and osteoporosis remains to be clarified. Using a population-based women's health survey in southern Sweden [Women's Health in the Lund Area (WHILA) ] with no known historical cadmium contamination, we investigated cadmium-related effects on bone in 820 women (53-64 years of age) . We measured cadmium in blood and urine and lead in blood, an array of markers of bone metabolism, and forearm bone mineral density (BMD) . Associations were evaluated in multiple linear regression analysis including information on the possible confounders or effect modifiers: weight, menopausal status, use of hormone replacement therapy, age at menarche, alcohol consumption, smoking history, and physical activity. Median urinary cadmium was 0.52 microg/L adjusted to density (0.67 microg/g creatinine) . After multivariate adjustment, BMD, parathyroid hormone, and urinary deoxypyridinoline (U-DPD) were adversely associated with concentrations of urinary cadmium (p < 0.05) in all subjects. These associations persisted in the group of never-smokers, which had the lowest cadmium exposure (mainly dietary) . For U-DPD, there was a significant interaction between cadmium and menopause (p = 0.022) . Our results suggest negative effects of low-level cadmium exposure on bone, possibly exerted via increased bone resorption, which seemed to be intensified after menopause. Based on the prevalence of osteoporosis and the low level of exposure, the observed effects, although slight, should be considered as early signals of potentially more adverse health effects. Key words: biochemical bone markers, bone mineral density, cadmium, lead, osteoporosis, women.

Effect of low-level lifetime exposure to cadmium on calciotropic hormones in aged female rats

The effect of low-level lifetime exposure to cadmium (Cd) on calciotropic hormones and the possible association between the Cd-induced disorders in bone metabolism and these hormones were investigated on a female rat model of human environmental exposure in areas unpolluted by this metal. For this purpose, the concentrations of 25-hydroxyvitamin D (25OHD), 1,25-dihydroxyvitamin D (1,25(OH)(2)D), calcitonin (CT) and parathormone (PTH) were measured in the serum of control and Cd-exposed (1 mg Cd/l in drinking water for 24 months) female rats. Calcium (Ca) and inorganic phosphorus (P(i)) serum concentrations, renal tubular reabsorption of Ca (TRCa) and phosphate (TRP) and the glomerular filtration rate (GFR) were estimated as well. Moreover, 1,25(OH)(2)D, metallothionein (MT) and Cd were determined in the kidney. The exposure to Cd led to a decrease in the serum concentrations of 25OHD and 1,25(OH)(2)D (by 50 and 31%, respectively) and the concentration of 1,25(OH)(2)D in the kidney mitochondrial fraction (by 55%). The serum concentrations of CT and PTH increased (5.2-fold and by 29%, respectively) and those of Ca and P(i) were unchanged, whereas the TRCa, TRP and GFR decreased due to the exposure to Cd. The results give evidence that the low lifetime exposure to Cd disturbs the metabolism of calciotropic hormones and damages the reabsorptive and filtrative function of the kidney in aged female rats. Numerous correlations noted between calciotropic hormones and the indices of kidney function, and indices of bone turnover and bone mineral status (bone mineral content and density) of these females indicate a relationship between these hormones and the kidney functional status and bone metabolism. The results of the present study together with our previous findings on the bone status in the experimental model allow for the conclusion that the low lifetime exposure to Cd by affecting the metabolism and proper function of calciotropic hormones may contribute to the advancement of bone damage at the elderly.

Urinary cadmium excretion is correlated with calcaneal bone mass in Japanese women living in an urban area

Nine hundred eight women aged 40-88 years living in a non-Cd-polluted area in Japan were analyzed for urinary cadmium (Cd), N-acetyl-beta-D-glucosaminidase (NAG) activity, beta(2)-microglobulin (B2MG) concentration, and for the stiffness index (STIFF) of calcaneal bone using an ultrasound method. The urinary Cd in the subjects, with a mean and range of 2.87 and 0.25-11.4 microg/g creatinine, respectively, showed a significant correlation with NAG but not with B2MG. STIFF was significantly inversely correlated with urinary Cd, and the association remained significant after adjusting for age, body weight, and menstrual status, suggesting a significant effect of Cd on the bone loss in these subjects without signs of Cd-induced kidney damage. A two-fold increase in urinary Cd was accompanied by a decrease in STIFF corresponding to a 1.7-year rise in age. These results emphasize the need for reassessment of the significance of Cd exposure in the general Japanese population.

Intravenous 1alpha, 25[OH]2 vitamin D3 (calcitriol) pulse therapy for bone lesions in a murine model of chronic cadmium toxicosis

The aim of the present study was to clarify the therapeutic effects of 1alpha, 25[OH]2 vitamin D3 (calcitriol) pulse injection on bone lesions induced in a rat model of chronic cadmium toxicosis. Ovariectomized (OVX) and control-operated (sham-OVX) rats were given repeated intravenous injections of 0.5 mg/kg/day CdCl2 for 70 weeks. The rats were then treated intravenously with 0.02 microg/kg/day calcitriol 3 days per week for 8 weeks. CdCl2 treatment induced increases in osteoid volumes of the femur cortex and trabecula. This change was accompanied by an increase in the volume of iron deposition at the mineralization front of the trabeculae and a reduction in mineral density. Abnormalities of bone metabolic parameters, which were increases in the blood calcium, inorganic phosphorous, bone-specific alkaline phosphatase, parathyroid hormone (PTH) and osteocalcin levels, and in the urine deoxypyridinoline (D-PYR) level, were also induced. Calcitriol treatment increased the blood calcium and inorganic phosphorous levels, and reduced the blood PTH level. Decreases in blood tartrate-resistant acid phosphatase and urine d-PYR levels were also induced indicating that bone resorption was suppressed. The findings indicated that the increased osteoid volume of the cortex and Fe-deposition volume of the trabecula were improved. These effects or improvements were observed in the sham-OVX rats but not in the OVX rats.

Ethanol inhibits cadmium accumulation in brains of offspring of pregnant rats that consume cadmium

The present study was designed to test the effect of ethanol on cadmium accumulation in tissues of pregnant rats and their offspring. Starting 10 days before mating and continuing until parturition, ethanol (10% v/v) was present in the drinking water of half the rats. Cadmium chloride (CdCl2; 50 ppm) was present in the water of half the rats (+/- ethanol) from the fist day after mating until parturition. On the day of parturition cadmium accumulated to a moderate level in bone (7.3 micrograms/g tissue, wet weight; this and other values, P < 0.05 vs. control), liver (12.9 micrograms/g) and kidney (13.0 micrograms/g) of dams, while the brain had only a low level of cadmium (0.45 microgram/g). In offspring at 6 weeks cadmium accumulated in high amounts in the brain (34.0 micrograms/g), bone (15.9 micrograms), kidney (78.2 micrograms/g) and particularly the liver (227.3 micrograms/g). Ethanol, given simultaneously with cadmium, inhibited cadmium accumulation in brain (1.8 micrograms/g), bone (3.28 micrograms/g) and kidney (61.3 micrograms/g), but enhanced cadmium accumulation in liver (408.7 micrograms/g). At 12 weeks there were only residual levels of cadmium in all tissues of offspring. These findings demonstrate an interaction between 2 known teratogenic agents, with ethanol conferring protection of the brain from cadmium accumulation. The nature of this interaction is not known, but is likely to be related to ethanol induction of metallothionein in the liver and placenta.