Arsenic, cadmium, and selenium exposures and bone mineral density-related endpoints: The HORTEGA study

Association Between Combined Polymetallic Exposure and Osteoporosis

Combined polymetallic exposure may be an influential factor in osteoporosis. This study aimed to explore the association between polymetallic combined exposure and osteoporosis. A total of 2115 participants were included. Plasma concentrations of 22 metals were determined by inductively coupled plasma mass spectrometry. Osteoporosis was defined as a T ≤  - 2.5. The least absolute shrinkage and selection operator (LASSO) regression, binary logistics regression, and Bayesian kernel machine regression (BKMR) model were used to explore the association between plasma metals and osteoporosis. LASSO regression showed that 10 metals were associated with osteoporosis in the total population (magnesium, calcium, manganese, nickel, cobalt, arsenic, selenium, rubidium, cadmium, aluminum) and women (magnesium, calcium, molybdenum, nickel, cobalt, arsenic, selenium, rubidium, cadmium, aluminum), and four metals associated with men (magnesium, cobalt, aluminum, iron). Logistics regression showed that in total population, magnesium (ORQ3 = 0.653, 95% CI = 0.446-0.954) was negatively correlated with osteoporosis, while aluminum (ORQ2 = 1.569, 95% CI = 1.095-2.248, ORQ4 = 1.616, 95% CI = 1.109-2.354) and cadmium (ORQ4 = 1.989, 95% CI = 1.379-2.870) were positively correlated; in women, magnesium (ORQ3 = 0.579, 95% CI = 0.379-0.883) was negatively correlated with osteoporosis, while aluminum (ORQ2 = 1.563, 95% CI = 1.051-2.326, ORQ4 = 1.543, 95% CI = 1.024-2.326) and cadmium (ORQ3 = 1.482, 95% CI = 1.003-2.191, ORQ4 = 1.740, 95% CI = 1.167-2.596) were positively correlated. BKMR model showed that combined polymetallic exposure had an overall positive effect on osteoporosis, magnesium was negatively associated with osteoporosis, and cadmium, selenium, and aluminum were positively associated with osteoporosis. Metal mixtures in plasma were associated with osteoporosis risk. Magnesium may reduce the risk of osteoporosis, while cadmium, selenium, and aluminum may increase the risk of osteoporosis. Future studies needed to explore correlations and mechanisms.

HT-2 mycotoxin and selenium deficiency: Effects on Femur development and integrity in Young mice

Kashin-Beck Disease (KBD), an osteoarticular disorder, is potentially influenced by several factors, among which selenium deficiency and HT-2 mycotoxin exposure are considered significant. However, the combined effect of these factors on femoral development remains unclear, Conducted over eight weeks on forty-eight male mice categorized into control, selenium-deficient, and HT-2 toxin-exposed groups, including dual-exposure sets, this study comprehensively monitored body weight, bone metabolism markers, and cellular health. Employing biomechanical analysis, micro-computed tomography (micro-CT), and transmission electron microscopy (TEM), we unearthed a reduction in body weight due to HT-2 toxin alone, with selenium deficiency exacerbating these effects synergistically. Our results unveil that both factors independently affect bone metabolism, yet their confluence leads to a pronounced degradation of bone health parameters, including alterations in calcium, phosphorus, and vitamin D levels, alongside marked changes in osteoblast and osteoclast activity and bone cell structures. The notable damage to femoral cortical and trabecular architectures underscores the perilous interplay between dietary selenium absence and HT-2 toxin presence, necessitating a deeper understanding of their separate and joint effects on bone integrity. These discoveries underscore the imperative for a nuanced approach to toxicology research and public health policy, highlighting the pivotal influence of environmental and nutritional factors on skeletal well-being.

Effects of selenium and iodine on Kashin-Beck disease: an updated review

Kashin-Beck disease (KBD) is an endochondral osteogenesis disorder characterised by epiphysis damage and secondary deformable arthropathy induced by multiple external factors, among which selenium (Se) and iodine deficiency are important influencing factors. Iodine deficiency is usually accompanied by a low Se content in the soil in the KBD areas of China. Se can reverse oxidative damage to chondrocytes. In addition, Se is related to the bone conversion rate and bone mineral density. Low Se will hinder growth and change bone metabolism, resulting in a decrease in the bone conversion rate and bone mineral density. Thyroid hormone imbalance caused by thyroid dysfunction caused by iodine deficiency can damage bone homeostasis. Compared with Se deficiency alone, Se combined with iodine deficiency can reduce the activity of glutathione peroxidase more effectively, which increases the vulnerability of chondrocytes and other target cells to oxidative stress, resulting in chondrocyte death. Clinical studies have shown that supplementation with Se and iodine is helpful for the prevention and treatment of KBD.

Associations Between Serum Selenium and Bone Mineral Density in 8-19-year-old children and adolescents: NHANES 2013-2018

The peak bone mass (PBM) in puberty has been proven to be a critical determinant of osteoporosis and brittle fractures in the elderly. Selenium is an essential trace element that could influence bone metabolism in our bodies. However, no study has investigated the impact of selenium status on bone mineral density (BMD) among children and adolescents. This was a cross-section study from National Health and Nutrition Examination Survey (NHANES) in the USA involving participants aged 8-19 years. We conducted multiple linear regression models to assess the relationship between selenium status and BMD among children and adolescents, and then stratified analyses were performed according to genders and races. Smooth curve fits and two-piecewise linear regression models were conducted to explore their nonlinear relationship. A total of 4570 participants (2338 boys and 2232 girls) were included in the present study, with a mean age of 13.57 ± 3.41 years. In the multivariable adjustment model, serum selenium was positively associated with lumbar spine BMD (β = 0.021 95% CI: 0.008, 0.034, P = 0.001). The dose-response analyses indicated a non-linear inverted U-shaped relationship between serum selenium and lumbar spine BMD. Lower and higher selenium concentrations were related to decreased BMD, and the inflection point of serum selenium was 2.60 umol/L. The inverted U-shaped association was also observed in females (inflection point: 2.49 umol/L), males (inflection point: 2.65 umol/L), Non-Hispanic White (inflection point: 2.50 umol/L), Non-Hispanic Black (inflection point: 2.50 umol/L), and other races (Including multi-racial) (inflection point: 2.81 umol/L). Our study first shows a non-linear inversed U-shaped association between selenium status and BMD among children and adolescents. The proper selenium status will benefit bone health in children and adolescents. More research is still required to verify our findings and their potential mechanisms.

Protective effects and mechanism of chemical- and plant-based selenocystine against cadmium-induced liver damage

Although selenium (Se) and cadmium (Cd) often coexist naturally in the soil of China, the health risks to local residents consuming Se-Cd co-enriched foods are unknown. In the present study, we investigated the effects of chemical-based selenocystine (SeCys2) on cadmium chloride-induced human hepatocarcinoma (HepG2) cell injury and plant (Cardamine hupingshanensis)-derived SeCys2 against Cd-induced liver injury in mice. We found that chemical- and plant-based SeCys2 showed protective effects against Cd-induced HepG2 cell injury and liver damage in mice, respectively. Compared with Cd intervention group, co-treatment with chemical- or plant-based SeCys2 both alleviated liver toxicity and ferroptosis by decreasing ferrous iron, acyl-CoA synthetase long-chain (ACSL) family member 4, lysophosphatidylcholine acyltransferase 3, reactive oxygen species and lipid peroxide levels, and increasing ACSL3, peroxisome proliferator-activated receptor α, solute carrier family 7 member 11 (SLC7A11) and glutathione and glutathione peroxidase 4 (GPX4) levels. In conclusion, chemical- and plant-based SeCys2 alleviated Cd-induced hepatotoxicity and ferroptosis by regulating SLC7A11/GPX4 signaling and lipid peroxidation. Our findings indicate that potential Cd toxicity from consuming foods grown in Se- and Cd-rich soils should be re-evaluated. This study offers a new perspective for the development of SeCys2-enriched agricultural products.

Effects of selenium-cadmium co-enriched Cardamine hupingshanensis on bone damage in mice

Selenium (Se) and cadmium (Cd) usually co-existed in soils, especially in areas with Se-rich soils in China. The potential health consequences for the local populations consuming foods rich in Se and Cd are unknown. Cardamine hupingshanensis (HUP) is Se and Cd hyperaccumulator plant that could be an ideal natural product to assess the protective effects of endogenous Se against endogenous Cd-caused bone damage. Male C57BL/6 mice were fed 5.22 mg/kg cadmium chloride (CdCl2) (Cd 3.2 mg/kg body weight (BW)), or HUP solutions containing Cd 3.2 mg/kg BW and Se 0.15, 0.29 or 0.50 mg/kg BW (corresponding to the HUP0, HUP1 and HUP2 groups) interventions. Se-enriched HUP1 and HUP2 significantly decreased Cd-induced femur microstructure damage and regulated serum bone osteoclastic marker levels and osteogenesis-related genes. In addition, endogenous Se significantly decreased kidney fibroblast growth factor 23 (FGF23) protein expression and serum parathyroid hormone (PTH) levels, and raised serum calcitriol (1,25(OH)2D3). Furthermore, Se also regulated gut microbiota involved in skeletal metabolism disorder. In conclusion, endogenous Se, especially with higher doses (the HUP2 group), positively affects bone formation and resorption by mitigating the damaging effects of endogenous Cd via the modulation of renal FGF23 expression, circulating 1,25(OH)2D3 and PTH and gut microbiota composition.

Update of the risk assessment of inorganic arsenic in food

The European Commission asked EFSA to update its 2009 risk assessment on arsenic in food carrying out a hazard assessment of inorganic arsenic (iAs) and using the revised exposure assessment issued by EFSA in 2021. Epidemiological studies show that the chronic intake of iAs via diet and/or drinking water is associated with increased risk of several adverse outcomes including cancers of the skin, bladder and lung. The CONTAM Panel used the benchmark dose lower confidence limit based on a benchmark response (BMR) of 5% (relative increase of the background incidence after adjustment for confounders, BMDL05) of 0.06 μg iAs/kg bw per day obtained from a study on skin cancer as a Reference Point (RP). Inorganic As is a genotoxic carcinogen with additional epigenetic effects and the CONTAM Panel applied a margin of exposure (MOE) approach for the risk characterisation. In adults, the MOEs are low (range between 2 and 0.4 for mean consumers and between 0.9 and 0.2 at the 95th percentile exposure, respectively) and as such raise a health concern despite the uncertainties.

Associations of multiple plasma metals with osteoporosis: findings from the Dongfeng-Tongji cohort

With the aging population, osteoporosis has become a more prevalent public health issue. Existing researches have indicated significant relations of single metal exposure with osteoporosis (e.g., lead, copper, and zinc), whereas the evidence regarding the joint association of metal mixtures with osteoporosis remain limited and inconclusive. A total of 4924 participants from the Dongfeng-Tongji cohort were included in the present study. Plasma levels of 23 metals were determined by inductively coupled plasma mass spectrometry, and the presence of osteoporosis was defined as a bone mineral density T-score ≤  - 2.5. We applied stepwise regression, plasma metal score, and quantile g-computation model to evaluate the association between plasma metal mixtures and osteoporosis risk. Of the 4924 participants, the prevalence of osteoporosis was 10.9% (N = 265) in males and 27.5% (N = 684) in females. In the multiple-metals model, arsenic was positively associated with osteoporosis in males, while zinc was positively associated with osteoporosis in females. Comparing extreme quartiles, the multivariate-adjusted ORs of osteoporosis were 2.20 (95% CI, 1.29, 3.79; P-trend = 0.006) for arsenic in males and 2.16 (95% CI, 1.44, 3.23; P-trend < 0.001) for zinc in females. The plasma metal score was significantly and positively associated with a higher risk of osteoporosis, with ORs (95% CI) comparing extreme quartiles were 5.00 (95% CI, 3.36, 7.65; P-trend < 0.001) in males and 1.76 (95% CI, 1.35, 2.29; P-trend < 0.001) in females. Furthermore, the results of quantile g-computation revealed a consistent positive trend of metal mixtures with risk of osteoporosis and suggested the dominant role of arsenic in males and zinc in females, respectively. Our findings highlighted the importance of controlling metal mixtures exposure for the prevention of osteoporosis in the middle-aged and elder population. Further prospective studies in larger populations are warranted to confirm our findings.

Associations of blood trace elements with bone mineral density: a population-based study in US adults

BACKGROUND

This study aimed to investigate the association between blood trace elements and bone mineral density (BMD) and to determine the association between blood trace elements and the risk of low BMD/osteoporosis among US adults.

METHODS

We performed a cross-sectional study using data from National Health and Nutrition Examination Survey (NHANES, 2011-2016). Multivariable linear regression models were employed to assess the associations of BMD in lumbar spine (LS-BMD), pelvic (PV-BMD) and total femur (TF-BMD) with blood trace elements, including Fe, Zn, Cu, Se, Mn, Cd, Pb, Hg. Additionally, the associations of low BMD/osteoporosis with blood trace elements were also evaluated using multivariable logistic regression.

RESULTS

Higher blood Pb levels were found associated with decreased LS-BMD (p for trend < 0.001), PV-BMD (p for trend = 0.007), and TF-BMD (p for trend = 0.003) in female, while higher blood Se levels were associated with increased PV-BMD in female (p for trend = 0.042); no linear association between BMD and other blood trace element was observed. Also, significant associations were found between Pb levels and the prevalence of low BMD (p for trend = 0.030) and the prevalence of osteoporosis (p for trend = 0.036), while association between other blood trace elements and low BMD/osteoporosis was not observed.

CONCLUSION

This study provides comprehensive insight into the association between blood trace elements and BMD and supports a detrimental effect of blood Pb levels on bone mass in women. Considering our analysis from a representative US general population, further study is warranted for the extreme levels of blood trace elements on bone metabolism.

Potential roles of gut microbiota in metal mixture and bone mineral density and osteoporosis risk association: an epidemiologic study in Wuhan

Few studies have focused on the effects of multiple metal mixtures on bone health and the underlying mechanisms related to alterations in the gut microbiota. This study aimed to examine the potential roles of gut microbiota alterations in metal mixtures and their association with osteoporosis traits. Adults aged ≥ 55 years were recruited from two community healthcare centers in Wuhan City during 2016-2019. The plasma concentrations of six metals (zinc, iron, selenium, lead, cadmium, and arsenic) were measured using an inductively coupled plasma mass spectrometer. The k-means clustering method was employed to explore the exposure profiles of metal mixtures for all participants. 16S rRNA gene sequencing was used to profile the gut microbiota of participants. Combining these results with those of our previous study, we identified overlapping taxa and evaluated their potential roles. A total of 806 participants (516 females), with an average age of 67.36 years were included. The participants were grouped into three clusters using k-means clustering: Cluster 1 (n = 458), Cluster 2 (n = 199), and Cluster 3 (n = 149). The high-exposure group for iron, zinc, lead, and cadmium (Cluster 3) showed a negative association with lumbar spine 1-4 bone mineral density (BMD). A total of 201 individuals (121 females) underwent sequencing of the gut microbiota. Both alpha and beta diversities were statistically different among the three groups. Bacteroidaceae, Lachnospiraceae, Bifidobacteriaceae, Bacteroides, and Lachnospiraceae_incertae_sedis were identified as overlapping taxa associated with the metal mixtures and BMD. Interaction analysis revealed that Cluster 3 interacted with Bacteroidaceae/Bacteroides, resulting in a positive effect on LS1-4 BMD (β = 0.358 g/cm2, 95% CI: 0.047 to 0.669, P = 0.025). Our findings indicate associations between multiple metal mixtures and BMD as well as gut microbiota alterations. Exploring the interaction between metal mixtures and the gut microbiota provides new perspectives for the precise prevention and treatment of osteoporosis.

Effects of urinary barium exposure on bone mineral density in general population

Previous studies have reported that exposures to metals are associated with bone health, but are mostly restricted to a few of the most frequent hazardous metals. The effects of barium (Ba) are not fully understood. A cross-sectional study involving 1532 adults from the National Health and Nutrition Examination Survey (NHANES, 2013-2016) was conducted. Generalized linear model (GLM) and restricted cubic spline (RCS) were applied to evaluate the relationship of urinary Ba exposure with BMDs. According to the GLM analyses, urinary Ba was adversely correlated with total BMD (percent change: -0.75; 95% CI: -1.21, -0.29) and lumbar BMD (percent change: -0.76; 95% CI: -1.47, -0.04). Compared with the lowest tertile of Ba levels, the percentage change of T3 was -2.06 (-3.36, -0.73) for total BMD and was -2.39 (-4.51, -0.24) for lumbar BMD, showing a significant linear trend (P trend = 0.014 and P trend = 0.047, respectively). The RCS models showed a monotonically decreasing relationship of urinary Ba with total BMD and lumbar BMD. Moreover, the positive joint effects were observed between Pb (lead) and Ba, and Cd (cadmium) and Ba on BMDs. According to our findings, exposure to Ba may lead to a decrease in BMDs. Possible positive joint effects of Ba and Pb, and Ba and Cd on BMDs were found. Exposure to Ba may contribute to poor skeletal health.

Association of selenium intake with bone mineral density and osteoporosis: the national health and nutrition examination survey

Background

Osteoporosis (OP) is a systemic metabolic skeletal disorder characterized by a decrease in bone mineral density (BMD) and an increase in the risk of fracture. The level of selenium (Se) in serum is associated with BMD. However, the relationship between dietary and total selenium intake and parameters such as osteoporosis and BMD is unclear. By conducting National Health and Nutritional Examination Surveys (NHANES), in this study, we assessed the association of Se intake with BMD and the risk of OP among general middle-aged and elderly people.

Methods

The data were collected from three cycles of NHANES [2009-2010, 2013-2014, and 2017-2020]. Information on the dietary and supplementary Se intake was obtained from 24-h dietary recall interviews. Additionally, dual-energy X-ray absorptiometry (DXA) was performed to measure BMD, which was later transformed into T-scores; OP was diagnosed when the T-score was ≤ -2.5. We constructed a logistic regression model for the association between selenium intake and the risk of OP based on the estimated odds ratios (ORs) and the 95% confidence intervals (CIs). We also constructed a multivariable linear regression model to analyze the relationship between selenium intake and BMD.

Results

In this study, 3,250 individuals (average age: 60.01 ± 10.09 years; 51.88% females) participated. The incidence of OP was 9.35% (3.30% for males and 17.75% for females). In the logistic regression model adjusted for every interested covariate, a higher quartile of dietary Se intake (OR for quartile 4 vs. quartile 1: 0.63; 95% CI: 0.41-0.96; P for trend = 0.027) was related to a lower risk of OP relative to the lowest quartile. The total selenium intake also exhibited a consistent trend (OR for quartile 4 vs. quartile 1: 0.67; 95% CI: 0.44-1.01; P for trend = 0.049). The results of the adjusted multivariate linear regression model showed that the participants with the highest quartile of dietary Se intake (Q4) had higher BMD in the total femur (β = 0.069, P = 0.001; P for trend = 0.001), femoral neck (β = 0.064, P = 0.001; P for trend = 0.001), and total spine (β = 0.030, P = 0.136; P for trend = 0.064) compared to those in quintile 1 (Q1). A similar trend of associations was observed for the total selenium intake with BMD, which was more prominent among females, as determined by the subgroup analysis.

Conclusion

In this study, the dietary intake and total intake of selenium were positively associated with BMD, whereas they were negatively associated with the risk of OP among adults in the US. Further studies are required to verify our results and elucidate the associated biological mechanism.

The association between selenium and bone health: a meta-analysis

Aims

Previous studies have suggested that selenium as a trace element is involved in bone health, but findings related to the specific effect of selenium on bone health remain inconclusive. Thus, we performed a meta-analysis by including all the relevant studies to elucidate the association between selenium status (dietary intake or serum selenium) and bone health indicators (bone mineral density (BMD), osteoporosis (OP), or fracture).

Methods

PubMed, Embase, and Cochrane Library were systematically searched to retrieve relevant articles published before 15 November 2022. Studies focusing on the correlation between selenium and BMD, OP, or fracture were included. Effect sizes included regression coefficient (β), weighted mean difference (WMD), and odds ratio (OR). According to heterogeneity, the fixed-effect or random-effect model was used to assess the association between selenium and bone health.

Results

From 748 non-duplicate publications, 19 studies were included. We found a significantly positive association between dietary selenium intake (β = 0.04, 95% confidence interval (CI) 0.00 to 0.07, p = 0.029) as well as serum selenium (β = 0.13, 95% CI 0.00 to 0.26, p = 0.046) and BMD. Consistently, those with higher selenium intake had a lower risk of OP (OR = 0.47, 95% CI 0.31 to 0.72, p = 0.001), and patients with OP had a significantly lower level of serum selenium than healthy controls (WMD = -2.01, 95% CI -3.91 to -0.12, p = 0.037). High dietary selenium intake was associated with a lower risk of hip fracture (OR = 0.44, 95% CI 0.37 to 0.52, p < 0.001).

Conclusion

Selenium was positively associated with BMD and inversely associated with OP; dietary selenium intake was negatively associated with hip fracture. The causality and therapeutic effect of selenium on OP needs to be investigated in future studies.

Association between dietary intake of α-tocopherol and cadmium related osteoporosis in population ≥ 50 years

INTRODUCTION

To analyze the association between α-tocopherol intake and cadmium (Cd) exposure and osteoporosis in population ≥ 50 years.

MATERIALS AND METHODS

Sociodemographic data, physical examination, and laboratory indicators including serum Cd level and dietary α-tocopherol intake of 8459 participants were extracted from the National Health and Nutrition Examination Survey (NHANES) database in this cross-sectional study. The associations between α-tocopherol intake, serum Cd levels and osteoporosis were evaluated using univariate and multivariate logistic regression analyses, with the estimated value (β), odds ratios (ORs) and 95% confidence intervals (CIs). We further explored the impact of α-tocopherol intake on Cd exposure and the bone mineral density (BMD) in total femur and femur neck.

RESULTS

A total of 543 old adults suffered from osteoporosis. The serum Cd level (0.52 μg/L vs. 0.37 μg/L) and α-tocopherol intake (5.28 mg vs. 6.50 mg) were statistical different in osteoporosis group and non-osteoporosis group, respectively. High level of Cd exposure was related to the increased risk of osteoporosis [OR = 1.60, 95% CI (1.15-2.21)]. In the total femur, α-tocopherol intake may improve the loss of BMD that associated with Cd exposure [β = - 0.047, P = 0.037]. Moreover, high α-tocopherol intake combined with low Cd exposure [OR = 0.54, 95% CI (0.36-0.81)] was linked to the decreased risk of osteoporosis comparing with low α-tocopherol intake combined with high Cd exposure.

CONCLUSION

High α-tocopherol intake may improve the Cd-related osteoporosis and loss of BMD that could provide some dietary reference for prevention of osteoporosis in population ≥ 50 years old.

Reactive Oxygen Species Control Osteoblast Apoptosis through SIRT1/PGC-1α/P53Lys382 Signaling, Mediating the Onset of Cd-Induced Osteoporosis

The imbalance between osteogenesis and osteoclastogenesis is a feature of bone metabolic disease. Cadmium (Cd) exposure causes human bone loss and osteoporosis (OP) through bioaccumulation of the food chain. However, the impact of Cd on bone tissues and the underlying molecular mechanisms are not well-characterized. In the current study, we found that the Cd concentration in bone tissues of OP patients was higher than normal subjects; meanwhile, the nuclear silent information regulator of transcription 1 (SIRT1) protein expression level was significantly decreased, which is a new star molecule to treat OP. It is further revealed that SIRT1 activation markedly reprograms bone metabolic and stress-response pathways that incline with osteoblast (OB) apoptosis. Suppressing reactive oxygen species (ROS) release with N-acetyl-l-cysteine (NAC) abolished Cd-induced reduction of SIRT1 protein, deacetylation of P53, OB apoptosis, and attenuated OP. Conversely, overexpression of SIRT1 suppressed Cd-induced ROS release. SIRT1 overexpression in vivo and in vitro dampened PGC-1α protein, acetylation of P53 at lysine 382, and caspase-dependent apoptosis. These results reveal that ROS/SIRT1 controls P53 acetylation and coordinates OB apoptosis involved in the onset of OP.

Combined Exposure to Multiple Metals and Kidney Function in a Midlife and Elderly Population in China: A Prospective Cohort Study

[Background] Metal exposure is suspected to be correlated to kidney function. However, the combined effects of co-exposing to multiple metals, especially both toxic and protective metals, have not been completely evaluated. [Method] A prospective cohort study was conducted with the "135" cohort for the evaluation of how plasma metal levels are correlated to kidney function in a midlife and elderly community in southern China. An amount of 1368 subjects without kidney disease at baseline were enrolled in the final analysis. By using linear regression and logistic regression models, the correlation of individual metal values with renal function parameters was assessed. Measuring of the multiple metal exposure level was performed by principal component analysis (PCA). [Results] Diminished renal function, as evaluated based on fast kidney function decline, or estimated glomerular filtration rate (eGFR) < 60 mL/min/1.73 m², was positively associated with the plasma concentrations of chromium and potassium, but it was negatively associated with selenium and iron (p < 0.05). In multiple-metal analyses, linear and logistic regression models showed that the iron and chromium exposure pattern had a protective effect on renal function, whereas the sodium and potassium exposure pattern and the cadmium and lead exposure pattern increased the risk for fast kidney function decline, and eGFR < 60 mL/min/1.73 m². [Conclusions] Certain metals, including chromium, potassium, selenium, and iron, were correlated with kidney function in a midlife and elderly community in China. In addition, the potential combined influences of co-exposing to multiple metals were observed.

Risk of Environmental Chemicals on Bone Fractures Is Independent of Low Bone Mass in US Adults: Insights from 2017 to 2018 NHANES

(1) Objective: To assess the association of environmental chemical factors with osteopenia and/or bone fractures. (2) Methods: All data were extracted from the National Health and Nutrition Survey (NHANES) 2017–2018 of American adults aged 20–59 years old; invalid data were excluded based on dual-energy X-ray absorptiometry. For the ultimate valid data set, multivariate logistic regression models were applied to evaluate the association of environmental chemical factors with osteopenia and bone fractures. (3) Results: The valid dataset was obtained from 2640 individuals, who completed a questionnaire of demographic characteristics. Urinary manganese and monomethylarsonic acid were positively associated with osteopenia in American adults, but not bone fracture. However, several environmental factors (e.g., arsenous acid, arsenocholine, dimethylarsinic acid, and 2-thioxothiazolidine-4-carboxylic acid) did not affect bone mineral density, but were significantly associated with bone fracture. (4) Conclusions: Multiple environmental chemical factors significantly affect bone mass or fracture risk. However, the risk of environmental chemical factors on fractures is independent of osteopenia in US Adults. The influence of environmental chemical factors on bone quality should be considered and monitored.

Association of habitually low intake of dietary selenium with new-onset stroke: A retrospective cohort study (2004-2015 China Health and Nutrition Survey)

Background

As an essential trace element in the body, selenium is associated with the development of many diseases. The purpose of this study was to explore the association between dietary selenium intake and new-onset stroke risk in Chinese adults.

Methods

Adults aged ≥18 years in the China Health and Nutrition Survey (CHNS) from 2004 to 2015 were enrolled. Participants were divided into five groups according to the quintile of dietary selenium intake: Q1 (≤ 29.80 μg/day), Q2 (29.80-38.53 μg/day), Q3 (38.53-47.23 μg/day), Q4 (47.23-60.38 μg/day), Q 5(>60.38 μg/day). Cox proportional-hazards model was used to explore the effect of dietary selenium on new-onset stroke. Restricted cubic spline (RCS) was used to visualize the dose-response relationship between dietary selenium and the risk of morbidity.

Results

A total of 11,532 subjects were included, and 271 (2.35%) of them developed stroke during a mean follow-up of 6.78 person-years. Compared with the lowest selenium intake group, the HR and 95%CI of stroke in the participants with selenium intake of Q2, Q3, Q4 and Q5 were: 0.85 (0.59, 1.21), 0.62 (0.42, 0.92), 0.43 (0.28, 0.68), 0.49 (0.30, 0.82), respectively. There was an L-shaped relationship between dietary selenium and stroke (nonlinear P-value = 0.0420). The HR and 95%CI of developing stroke was 0.75 (0.65, 0.87) in participants with selenium intake ≤ 60 μg/day.

Conclusions

The L-shaped negative association between dietary selenium and stroke in Chinese adults which indicated that dietary selenium should be improved to a certain level to prevent stroke.

Metabolomic patterns, redox-related genes and metals, and bone fragility endpoints in the Hortega Study

BACKGROUND

The potential joint influence of metabolites on bone fragility has been rarely evaluated. We assessed the association of plasma metabolic patterns with bone fragility endpoints (primarily, incident osteoporosis-related bone fractures, and, secondarily, bone mineral density BMD) in the Hortega Study participants. Redox balance plays a key role in bone metabolism. We also assessed differential associations in participant subgroups by redox-related metal exposure levels and candidate genetic variants.

MATERIAL AND METHODS

In 467 participants older than 50 years from the Hortega Study, a representative sample from a region in Spain, we estimated metabolic principal components (mPC) for 54 plasma metabolites from NMR-spectrometry. Metals biomarkers were measured in plasma by AAS and in urine by HPLC-ICPMS. Redox-related SNPs (N = 341) were measured by oligo-ligation assay.

RESULTS

The prospective association with incident bone fractures was inverse for mPC1 (non-essential and essential amino acids, including branched-chain, and bacterial co-metabolites, including isobutyrate, trimethylamines and phenylpropionate, versus fatty acids and VLDL) and mPC4 (HDL), but positive for mPC2 (essential amino acids, including aromatic, and bacterial co-metabolites, including isopropanol and methanol). Findings from BMD models were consistent. Participants with decreased selenium and increased antimony, arsenic and, suggestively, cadmium exposures showed higher mPC2-associated bone fractures risk. Genetic variants annotated to 19 genes, with the strongest evidence for NCF4, NOX4 and XDH, showed differential metabolic-related bone fractures risk.

CONCLUSIONS

Metabolic patterns reflecting amino acids, microbiota co-metabolism and lipid metabolism were associated with bone fragility endpoints. Carriers of redox-related variants may benefit from metabolic interventions to prevent the consequences of bone fragility depending on their antimony, arsenic, selenium, and, possibly, cadmium, exposure levels.

Long-Term Selenium-Yeast Supplementation Does Not Affect Bone Turnover Markers: A Randomized Placebo-Controlled Trial

Higher selenium status has been associated with lower bone turnover markers (BTM) in epidemiological studies. However, the long-term impact of selenium supplementation on BTMs has not been studied. We investigated the effects of selenium supplementation on BTMs including osteocalcin (OC), procollagen type I N-terminal propeptide (PINP), collagen type I cross-linked C-telopeptide (CTX), and bone alkaline phosphatase (BALP) in the short (6 months) and long term (5 years). A total of 481 Danish men and women (60-74 years) were randomized to receive placebo-yeast versus 100, 200, or 300 μg selenium as selenium-enriched yeast daily for 5 years. Plasma selenium concentration was measured using inductively coupled plasma mass spectrometry, and BTMs were measured in nonfasted samples at baseline, 6 months, and 5 years. Data were analyzed by ANCOVA to investigate the shape of the dose-response relationships. Covariates included age, body mass index, baseline selenium status, baseline BTM, smoking, alcohol, supplement use, and medication. Plasma selenium concentration (mean 86.5 μg/d at baseline) increased significantly with increasing selenium supplementation to 152.6, 209.1, and 253.7 μg/L after 6 months and remained elevated at 5 years (158.4, 222.4, and 275.9 μg/L for 100, 200, and 300 μg supplemental selenium/d, respectively (p < 0.001)). There was no change in plasma selenium concentration in the placebo-treated group. There was no significant effect of selenium supplementation on OC (6 months p = 0.37; 5 years p = 0.63), PINP (6 months p = 0.37; 5 years p = 0.79), CTX (6 months p = 0.91; 5 years p = 0.58) or BALP (6 months p = 0.17; 5 years p = 0.53). The relatively replete baseline selenium status in the study participants may explain this lack of effect. Testing in more deficient populations may provide further insights into the impact of selenium supplementation on bone health. © 2022 The Authors. Journal of Bone and Mineral Research published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research (ASBMR).

Progress of Selenium Deficiency in the Pathogenesis of Arthropathies and Selenium Supplement for Their Treatment

Selenium, an essential trace element for human health, exerts an indispensable effect in maintaining physiological homeostasis and functions in the body. Selenium deficiency is associated with arthropathies, such as Kashin-Beck disease, rheumatoid arthritis, osteoarthritis, and osteoporosis. Selenium deficiency mainly affects the normal physiological state of bone and cartilage through oxidative stress reaction and immune reaction. This review aims to explore the role of selenium deficiency and its mechanisms existed in the pathogenesis of arthropathies. Meanwhile, this review also summarized various experiments to highlight the crucial functions of selenium in maintaining the homeostasis of bone and cartilage.

Manganese, iron, copper, and selenium co-exposure and osteoporosis risk in Chinese adults

BACKGROUND & AIMS

Previous experimental studies demonstrated that either deficient or excessive trace elements, such as manganese (Mn), iron (Fe), copper (Cu) and selenium (Se), are detrimental to bone health. Epidemiologic evidence for the effect of the four trace elements on osteoporosis (OP) risk remains inadequate. This cross-sectional study aimed to examine their associations with the OP risk among Chinese adults.

METHODS

Concentrations of Mn, Fe, Cu, and Se were measured in plasma using an inductively coupled plasma mass spectrometer among 627 Chinese adults aged ≥ 50 years. Individual effect of the four elements on OP risk was analyzed by logistic regression and Bayesian Kernel Machine Regression (BKMR) models. The latter model was also adopted to examine the exposure-response relationships and joint effects of the four elements on OP risk.

RESULTS

The median Mn, Fe, Cu, and Se levels were 4.78, 1026.63, 904.55, and 105.39 μg/L, respectively, in all participants. Inverse associations of Fe and Se levels with OP risk were observed in the logistic regression model. BKMR analysis revealed a U-shape pattern for the Fe-OP association, and a reduced OP risk in response to co-exposure of the four elements above the 50th percentiles but an elevated one in response to that below the 50th percentiles. Sex discrepancy existed in the findings. No interactions were found for the four elements affecting OP risk.

CONCLUSIONS

Co-exposure to Mn, Fe, Cu, and Se was associated with improved bone density, where Fe contributed most to the beneficial effect. Further studies are needed to verify these findings and explore the underlying biological mechanism.

Gene-environment interaction analysis of redox-related metals and genetic variants with plasma metabolic patterns in a general population from Spain: The Hortega Study

Background

Limited studies have evaluated the joint influence of redox-related metals and genetic variation on metabolic pathways. We analyzed the association of 11 metals with metabolic patterns, and the interacting role of candidate genetic variants, in 1145 participants from the Hortega Study, a population-based sample from Spain.

Methods

Urine antimony (Sb), arsenic, barium (Ba), cadmium (Cd), chromium (Cr), cobalt (Co), molybdenum (Mo) and vanadium (V), and plasma copper (Cu), selenium (Se) and zinc (Zn) were measured by ICP-MS and AAS, respectively. We summarized 54 plasma metabolites, measured with targeted NMR, by estimating metabolic principal components (mPC). Redox-related SNPs (N = 291) were measured by oligo-ligation assay.

Results

In our study, the association with metabolic principal component (mPC) 1 (reflecting non-essential and essential amino acids, including branched chain, and bacterial co-metabolism versus fatty acids and VLDL subclasses) was positive for Se and Zn, but inverse for Cu, arsenobetaine-corrected arsenic (As) and Sb. The association with mPC2 (reflecting essential amino acids, including aromatic, and bacterial co-metabolism) was inverse for Se, Zn and Cd. The association with mPC3 (reflecting LDL subclasses) was positive for Cu, Se and Zn, but inverse for Co. The association for mPC4 (reflecting HDL subclasses) was positive for Sb, but inverse for plasma Zn. These associations were mainly driven by Cu and Sb for mPC1; Se, Zn and Cd for mPC2; Co, Se and Zn for mPC3; and Zn for mPC4. The most SNP-metal interacting genes were NOX1, GSR, GCLC, AGT and REN. Co and Zn showed the highest number of interactions with genetic variants associated to enriched endocrine, cardiovascular and neurological pathways.

Conclusions

Exposures to Co, Cu, Se, Zn, As, Cd and Sb were associated with several metabolic patterns involved in chronic disease. Carriers of redox-related variants may have differential susceptibility to metabolic alterations associated to excessive exposure to metals.

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In a population-based sample, cobalt, copper, selenium, zinc, arsenic, cadmium and antimony exposures were related to some metabolic patterns.

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Carriers of redox-related variants displayed differential susceptibility to metabolic alterations associated to excessive metal exposures.

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Cobalt and zinc showed a number of statistical interactions with variants from genes sharing biological pathways with a role in chronic diseases.

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The metabolic impact of metals combined with variation in redox-related genes might be large in the population, given metals widespread exposure.

Factors Affecting the Aluminum, Arsenic, Cadmium and Lead Concentrations in the Knee Joint Structures

Background: Toxic elements, such as aluminum (Al), arsenic (As), cadmium (Cd), and lead (Pb), are persistent environmental pollutants that can cause adverse effects on the health of exposed individuals. Bone is one of the primary target organs of accumulation and potential damage from toxic elements. Objectives: This study was performed to determine the Al, As, Cd, and Pb concentrations in the femoral cancellous bone, femoral cartilage, anterior cruciate ligament, meniscus, tibial cartilage, tibial cancellous bone and infrapatellar fat pad. Furthermore, the aim of this study was to explore the relationships between toxic element concentrations and related factors such as gender, age, place of residence, hypertension and diabetes, and to determine the correlations among these toxic elements in knee joint structures. Methods: The samples used this study were collected from 51 patients following total knee arthroplasty. The Al, As, Cd, and Pb concentrations were determined using inductively coupled plasma optic emission spectrometry. Results: Significant differences were found in the Al, As, Cd, and Pb concentrations among the knee joint structures. Cd concentration in the tibial cancellous bone in women was significantly higher than in men. Pb concentration in the infrapatellar fat pad of urban patients was significantly higher as compared to rural patients. Al concentrations in the femoral cancellous bone, femoral cartilage, anterior cruciate ligament, meniscus and tibial cartilage were significantly higher in patients living in urban areas than in rural areas. As concentration in the tibial cancellous bone of diabetic patients was significantly higher compared to non-diabetic patients. In addition, significant Spearman's positive correlations were found between Al and Pb in the knee joint structures. Conclusion: The obtained results of the investigated toxic elements may serve as a basis for establishing the reference values of Al, As, Cd, and Pb in the knee joint structures. The results reported in the study provides novel data regarding the relationships between the toxic element concentrations and gender, age, place of residence, hypertension and diabetes in the studied structures of knee joint. Furthermore, new interactions among these toxic elements were noted.

The Effects of Selenium on Bone Health: From Element to Therapeutics

Osteoporosis, characterized by low bone mass and a disruption of bone microarchitecture, is traditionally treated using drugs or lifestyle modifications. Recently, several preclinical and clinical studies have investigated the effects of selenium on bone health, although the results are controversial. Selenium, an important trace element, is required for selenoprotein synthesis and acts crucially for proper growth and skeletal development. However, the intake of an optimum amount of selenium is critical, as both selenium deficiency and toxicity are hazardous for health. In this review, we have systematically analyzed the existing literature in this field to determine whether dietary or serum selenium concentrations are associated with bone health. In addition, the mode of administration of selenium as a supplement for treating bone disease is important. We have also highlighted the importance of using green-synthesized selenium nanoparticles as therapeutics for bone disease. Novel nanobiotechnology will be a bridgehead for clinical applications of trace elements and natural products.

Risk Factors Analysis of Bone Mineral Density Based on Lasso and Quantile Regression in America during 2015-2018

This study aimed to explore the risk factors of bone mineral density (BMD) in American residents and further analyse the extent of effects, to provide preventive guidance for maintenance of bone health. A cross-sectional study analysis was carried out in this study, of which data validity was identified and ethics approval was exempted based on the National Health and Nutrition Examination Survey (NHANES) database. Candidates' demographics, physical examination, laboratory indicators and part of questionnaire information were collected and merged from NHANES in 2015-2016 and 2017-2018. The least absolute shrinkage selection operator (lasso) was used to select initial variables with "glmnet" package of R, quantile regression model to analyze influence factors of BMD and their effects in different sites with "qreg" code in Stata. Among 2937 candidates, 17 covariates were selected by lasso regression (λ = 0.00032) in left arm BMD, with 16 covariates in left leg BMD (λ = 0.00052) and 14 covariates in total BMD (λ = 0.00065). Quantile regression results displayed several factors with different coefficients in separate sites and quantiles: gender, age, educational status, race, high-density lipoprotein (HDL), total cholesterol (TC), lead, manganese, ethyl mercury, smoking, alcohol use and body mass index (BMI) (p < 0.05). We constructed robust regression models to conclude that some demographic characteristics, nutritional factors (especially lipid levels, heavy metals) and unhealthy behaviors affected BMD in varying degrees. Gender and race differences, Low-fat food intake and low exposure to heavy metals (mostly lead, manganese and mercury) should be considered by both clinical doctors and people. There is still no consensus on the impact of smoking and alcohol use on bone mineral density in our study.

Associations of multiple metals with bone mineral density: A population-based study in US adults

Epidemiologic studies focus on combined effects of multiple metals on bone mineral density (BMD) are scarce. Therefore, this study was conducted to examine associations of multiple metals exposure with BMD. Data of adults aged ≥20 years (n = 2545) from the US National Health and Nutrition Examination Survey (NHANES, 2011-2016) were collected and analyzed. Concentrations of metals were measured in blood (cadmium [Cd], lead [Pb], mercury [Hg], and manganese [Mn]) and serum (copper [Cu], selenium [Se], and zinc [Zn]) using inductively coupled plasma mass spectrometry and inductively coupled plasma dynamic reaction cell mass spectrometry, respectively. The weighted quantile sum (WQS) and Bayesian kernel machine regression (BKMR) models were performed to determine the joint effects of multiple metals exposure on lumbar and total BMD. The linear regression analyses showed Pb was negatively associated with BMDs. The WQS regression analyses revealed that the WQS index was inversely related to lumbar (β = -0.022, 95% CI: -0.036, -0.008) and total BMD (β = -0.015, 95% CI: -0.024, -0.006), and Se, Mn, and Pb were the main contributors for the combined effects. Additionally, nonlinear dose-response relationships between Pb, Mn, and Se and BMD, as well as a synergistic interaction of Pb and Mn, were found in the BKMR analyses. Our findings suggested co-exposure to Cd, Pb, Hg, Mn, Cu, Se, and Zn (above their 50th percentiles) was associated with reduced BMD, and Pb, Mn, and Se were the main contributors driving the overall effects.

Selenium-modified calcium phosphate cement can accelerate bone regeneration of osteoporotic bone defect

OBJECTIVE

The purpose is to observe whether local administration with selenium (Se) can enhance the efficacy of calcium phosphate cement (CPC) in the treatment of osteoporotic bone defects.

METHODS

Thirty ovariectomized (OVX) rats with two defects were generated and randomly allocated into the following graft study groups: (1) OVX group (n = 10), (2) CPC group (n = 10); and (3) Se-CPC group (n = 10). Then, these selenium-modified calcium phosphate cement (Se-CPC) scaffolds were implanted into the femoral epiphysis bone defect model of OVX rats for 12 weeks. Micro-CT, history, western blot and reverse transcription-quantitative polymerase chain reaction (RT-qPCR) analysis were used to observe the therapeutic effect and to explore the possible mechanism.

RESULT

Micro-CT and histological analysis evaluation showed that the Se-CPC group presented the strongest effect on bone regeneration and bone mineralization when compared with the CPC group and the OVX group. Protein expressions showed that the oxidative stress protein expressions, such as SOD2 and GPX1 of the Se-CPC group, are significantly higher than those of the OVX group and the CPC group, while Se-CPC remarkably reduced the expression of CAT. RT-qPCR analysis showed that the Se-CPC group displayed more OPG than the OVX and CPC groups (p < 0.05), while Se-CPC exhibited less RANKL than the OVX and CPC groups (p < 0.05).

CONCLUSION

Our current study demonstrated that Se-CPC is a scheme for rapid repair of femoral condylar defects, and these effects may be achieved by inhibiting local oxidative stress and through OPG/RANKL signaling pathway.

Higher Dietary Se Intake Is Associated With the Risk of New-Onset Fracture: A National Longitudinal Study for 20 Years

Background: The association between dietary selenium (Se) intake and osteoporosis-related fractures remains inconsistent. We aimed to examine the dose relationship between Se intake and incident fracture among Chinese adults. Methods: The dietary data were retrieved from the China Health and Nutrition Survey conducted between 1991 and 2011, and 17,150 participants aged above 20 were included. A 3-day, 24-h recall of food intake was performed to assess cumulative average dietary Se intake. The fracture was based on self-report in each survey between 1997 and 2011. The association between Se intake and fracture was tested by Cox regression, and the non-linear association was examined by restricted cubic splines (RCS). Results: There were 976 fracture cases during a mean of 10.2 years follow-up. In a fully adjusted Cox model, across the quartiles of Se intake, the hazard ratios (HRs) for fracture were 1.07 (95% CI .86-1.33), 1 (reference), 1.25 (95% CI 1.02-1.53), and 1.33 (95% CI 1.07-1.65). RCS showed a parabolic association (P non-linear = 0.037) between Se and fracture for men as well as a U-shape dose-response (P non-linear = 0.04) between Se and fracture for subjects living in highly urbanized areas. Conclusion: In conclusion, there is a non-linear association between selenium intake and fracture, with higher intake associated with increased risk. The shape of the association varies by gender and urbanization level.

Alcohol Consumption Moderated the Association Between Levels of High Blood Lead or Total Urinary Arsenic and Bone Loss

Metal exposure and lifestyle are important risk factors for osteoporosis. Our study aimed to investigate the association between red blood cell lead and cadmium, total urinary arsenic, and plasma selenium levels and bone mineral density (BMD). In addition, we explored whether alcohol and coffee consumption modified the association between BMD and metals and metalloids. In total, 437 participants who underwent adult or senile physical examinations were recruited. Bone loss was defined as a calcaneus BMD T-score of <-1. Blood cadmium and lead and plasma selenium levels were measured using inductively coupled plasma mass spectrometry. Levels of urinary arsenic species were determined using high-performance liquid chromatography-hydride generator-atomic absorption spectrometry. The total urinary arsenic level was defined as the sum of the levels of urinary arsenic species. The BMD T-scores decreased significantly with increasing blood lead levels. The BMD T-scores also showed a downward trend with increasing total urinary arsenic levels. The odds ratio (OR) and 95% confidence interval (CI) for bone loss in patients with blood lead levels >57.58 versus 35.74 μg/dL were 1.98 and 1.17-3.34. In addition, the greater the lead or arsenic exposure and alcohol intake was the higher the OR for bone loss with multivariate ORs of 2.57 (95% CI 1.45-4.56) and 2.96 (95% CI 1.67-5.22), respectively. To the best of our knowledge, this study is the first to demonstrate that high total urinary arsenic or blood lead levels and frequent or occasional alcohol consumption had a significant multiplicative interaction for increasing the OR for bone loss.