{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,30]],"date-time":"2026-04-30T12:56:24Z","timestamp":1777553784284,"version":"3.51.4"},"reference-count":24,"publisher":"SAGE Publications","issue":"1","license":[{"start":{"date-parts":[[2026,1,1]],"date-time":"2026-01-01T00:00:00Z","timestamp":1767225600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2026,1,1]],"date-time":"2026-01-01T00:00:00Z","timestamp":1767225600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Dose-Response"],"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>This study investigates the association between blood cobalt levels and osteoporosis prevalence in the general U.S. population, addressing critical gaps in understanding low-to-moderate environmental exposure effects.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We analyzed 2901 adults from NHANES 2017-2020. Blood cobalt concentrations were categorized into quartiles. Multivariable logistic regression, restricted cubic splines (RCS), and Boruta algorithm were employed to assess dose-response relationships, nonlinear associations, and demographic effect modifications, adjusting for sociodemographic, metabolic, and clinical covariates.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Participants in the highest cobalt quartile showed 32% increased osteoporosis prevalence vs Q1 (OR = 1.32, 95% CI:1.06-1.86). RCS analysis revealed a nonlinear relationship with an inflection point at 0.12\u00a0\u03bcg\/L. Significant effect modifications emerged across multiple strata: females exhibited 91% greater risk elevation than males (OR = 1.91 vs 1.24, p-interaction = 0.022), Non-Hispanic Black participants demonstrated 36-fold higher odds (OR = 36.54, 95% CI:7.17-186.28), and participants with 9-11 years education showed elevated risk (OR = 21.72, 95% CI:1.27-372.63, p-interaction = 0.009). Married individuals exhibited higher risk (OR = 2.08, 95% CI:1.14-3.82) compared to never-married counterparts, though marital status interaction was nonsignificant (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = 0.721).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Environmental cobalt levels below current safety thresholds may associate with elevated osteoporosis prevalence, particularly in females and Non-Hispanic Black populations. The nonlinear dose-response relationship (inflection point 0.12\u00a0\u03bcg\/L) suggests threshold effects, advocating for revised biomonitoring standards and targeted screening in vulnerable subgroups.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/15593258261417145","type":"journal-article","created":{"date-parts":[[2026,1,20]],"date-time":"2026-01-20T04:20:21Z","timestamp":1768882821000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["The Association Between Cobalt and Osteoporosis: A Cross-Sectional Study Utilizing NHANES Data"],"prefix":"10.1177","volume":"24","author":[{"ORCID":"https:\/\/orcid.org\/0009-0004-9313-2068","authenticated-orcid":false,"given":"He","family":"Liu","sequence":"first","affiliation":[{"name":"Nanjing Tongren Hospital Affiliated to Medical College of Southeast University"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yilong","family":"Hu","sequence":"additional","affiliation":[{"name":"Department of General Surgery of the International Medical Center, The Fourth Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jianmin","family":"Liu","sequence":"additional","affiliation":[{"name":"Nanjing Tongren Hospital Affiliated to Medical College of Southeast University"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2026,1,19]]},"reference":[{"key":"e_1_3_8_2_2","doi-asserted-by":"publisher","DOI":"10.4314\/jasem.v27i9.6"},{"key":"e_1_3_8_3_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.freeradbiomed.2022.11.007"},{"key":"e_1_3_8_4_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12889-022-13965-5"},{"key":"e_1_3_8_5_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jtemb.2023.127141"},{"key":"e_1_3_8_6_2","doi-asserted-by":"publisher","DOI":"10.3389\/fnut.2021.708069"},{"key":"e_1_3_8_7_2","doi-asserted-by":"publisher","DOI":"10.3390\/toxics12120866"},{"key":"e_1_3_8_8_2","doi-asserted-by":"publisher","DOI":"10.1515\/cclm-2012-0688"},{"key":"e_1_3_8_9_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijheh.2007.07.018"},{"key":"e_1_3_8_10_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12302-021-00492-0"},{"key":"e_1_3_8_11_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12889-025-21825-1"},{"key":"e_1_3_8_12_2","doi-asserted-by":"publisher","DOI":"10.1080\/15459624.2022.2088769"},{"key":"e_1_3_8_13_2","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-147-8-200710160-00010"},{"key":"e_1_3_8_14_2","doi-asserted-by":"publisher","DOI":"10.1097\/EE9.0000000000000104"},{"key":"e_1_3_8_15_2","doi-asserted-by":"publisher","DOI":"10.1038\/s41598-024-65925-1"},{"key":"e_1_3_8_16_2","doi-asserted-by":"publisher","DOI":"10.3389\/fmars.2023.1238837"},{"key":"e_1_3_8_17_2","doi-asserted-by":"publisher","DOI":"10.3390\/ijms231911664"},{"key":"e_1_3_8_18_2","doi-asserted-by":"publisher","DOI":"10.1186\/s13058-019-1110-7"},{"key":"e_1_3_8_19_2","doi-asserted-by":"publisher","DOI":"10.52406\/ptnm.v1i1.55"},{"key":"e_1_3_8_20_2","doi-asserted-by":"publisher","DOI":"10.1177\/11786302241260487"},{"key":"e_1_3_8_21_2","doi-asserted-by":"publisher","DOI":"10.3390\/nu13041178"},{"key":"e_1_3_8_22_2","doi-asserted-by":"publisher","DOI":"10.3390\/antiox12030612"},{"key":"e_1_3_8_23_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jece.2022.108143"},{"key":"e_1_3_8_24_2","doi-asserted-by":"publisher","DOI":"10.3390\/ijerph19031257"},{"key":"e_1_3_8_25_2","doi-asserted-by":"publisher","DOI":"10.3390\/ijms232113435"}],"container-title":["Dose-Response"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/15593258261417145","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/15593258261417145","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/15593258261417145","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,28]],"date-time":"2026-04-28T18:03:04Z","timestamp":1777399384000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/15593258261417145"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,1]]},"references-count":24,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2026,1]]}},"alternative-id":["10.1177\/15593258261417145"],"URL":"https:\/\/doi.org\/10.1177\/15593258261417145","relation":{},"ISSN":["1559-3258","1559-3258"],"issn-type":[{"value":"1559-3258","type":"print"},{"value":"1559-3258","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,1]]},"article-number":"15593258261417145"}}