Bone Fracture Risk and Renal Dysfunction in a Highly Cadmium Exposed Thai Population

Kowit Nambunmee, Muneko Nishijo, Witaya Swaddiwudhipong, Werawan Ruangyuttikarn


Background: Paddy fields in the Mae Sot, Tak Province of Thailand are polluted with unsafe levels of cadmium (Cd). Elderly populations have a high Cd body burden, putting them at elevated risk of renal dysfunction and bone fractures. We aimed to compare bone fracture risk between glomerular dysfunction, proximal tubular dysfunction, and calcium (Ca) handling abnormalities.

Study design: A cross-sectional study.

Methods: Serum osteocalcin and cross-linked N-telopeptide of type I collagen were used to detect bone metabolism abnormalities, whereas glomerular filtration rate, serum cystatin C, urinary β2-microglobulin (β2-MG) and fractional excretion of calcium (FECa) were used to indicate renal dysfunction. Urinary Cd was used as an exposure marker.

Results: FECa >2% was associated with high bone fracture risk in both genders. The adjusted odds of bone fracture risk were 6.029 and 3.288 in men and women, respectively with FECa >2% relative to the FECa <2% group. Proximal tubular dysfunction and glomerular dysfunction did not significantly relate to the risk of bone fracture.

Conclusions: Abnormal Ca handling is a key risk factor for bone fracture in Cd-exposed people. Men and women were at risk of bone fracture risk at a similar rate. FECa was a specific indicator of Ca wasting and was more cost-effective compared to β2-MG and serum cystatin C. We recommend using FECa to monitor abnormal Ca metabolism in individuals with FECa>2%. Reduced renal toxicant exposure and Ca supplementation are recommended for Cd-exposed populations to reduce bone fracture risk.


Cadmium poisoning; Proximal renal tubular dysfunction; Calcium metabolism disorder; Thailand; Bone demineralization; Pathologic

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