Cigarette smoking is a risk factor for osteoporosis and bone fracture. Moreover, smoking causes exposure to cadmium, which is a known risk factor for osteoporosis. It is hypothesized that part of smoking‐induced osteoporosis may be mediated via cadmium from tobacco smoke. We investigated this hypothesis using mediation analysis in a Swedish cohort of elderly men. This study was performed in 886 elderly men from the Swedish cohort of the Osteoporotic Fractures in Men (MrOS) study. Urinary samples, bone mineral density (BMD), smoking data, and other background information were obtained at baseline in 2002–2004. Urinary cadmium was analyzed in baseline samples and adjusted for creatinine. The cohort was followed until August 2018 for fracture incidence, based on the X‐ray register. Mediation analysis was conducted to evaluate the indirect effect (via cadmium) of smoking on both BMD and fractures. Time to first fracture was analyzed using the accelerated failure time (AFT) model and Aalen's additive hazard model. The mean level of urinary cadmium was 0.25 μg/g creatinine. There were significant inverse associations between smoking and total body, total hip, and trochanter BMD. The indirect effects via cadmium were estimated to be 43% of the total effects of smoking for whole‐body BMD, and even more for total hip and trochanter BMD. Smoking was also associated with higher risk of all fractures and major osteoporosis fractures. The indirect effects via cadmium were largest in nonvertebral osteoporosis fractures and hip fractures, constituting at least one‐half of the total effects, in both the AFT and Aalen's model. The findings in this study provide evidence that cadmium exposure from tobacco smoke plays an important role in smoking‐induced osteoporosis © 2020 The Authors. Journal of Bone and Mineral Research published by American Society for Bone and Mineral Research.

中文翻译：

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吸烟引起的骨质疏松症风险部分是由烟草烟雾中的镉介导的：MrOS 瑞典研究。


吸烟是骨质疏松症和骨折的危险因素。此外，吸烟会导致镉接触，这是骨质疏松症的已知危险因素。据推测，吸烟引起的骨质疏松症部分可能是通过烟草烟雾中的镉介导的。我们通过对瑞典老年男性队列的中介分析来研究这一假设。这项研究是在来自瑞典男性骨质疏松性骨折 (MrOS) 研究队列的 886 名老年男性中进行的。尿液样本、骨矿物质密度 (BMD)、吸烟数据和其他背景信息是在 2002-2004 年基线时获得的。对基线样本中的尿镉进行分析，并根据肌酐进行调整。根据 X 射线记录，对队列的骨折发生率进行跟踪直至 2018 年 8 月。进行中介分析以评估吸烟（通过镉）对 BMD 和骨折的间接影响。使用加速失效时间 (AFT) 模型和 Aalen 的附加危险模型分析首次断裂的时间。尿镉平均水平为 0.25 μg/g 肌酐。吸烟与全身、全髋和转子 BMD 之间存在显着的负相关。据估计，镉的间接影响占吸烟对全身 BMD 总影响的 43%，对总髋部和转子 BMD 的影响甚至更大。吸烟还与所有骨折和主要骨质疏松性骨折的较高风险相关。在 AFT 和 Aalen 模型中，镉的间接影响在非椎体骨质疏松性骨折和髋部骨折中最大，至少占总影响的一半。这项研究的结果提供了证据，表明烟草烟雾中的镉暴露在吸烟引起的骨质疏松症中起着重要作用 © 2020 作者。 美国骨与矿物质研究学会出版的《骨与矿物质研究杂志》 。