{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,23]],"date-time":"2025-10-23T01:11:43Z","timestamp":1761181903936,"version":"build-2065373602"},"reference-count":30,"publisher":"Public Library of Science (PLoS)","issue":"10","license":[{"start":{"date-parts":[[2025,10,22]],"date-time":"2025-10-22T00:00:00Z","timestamp":1761091200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"The project was financed by the Royal Irrigation Department, Thailand."}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:p>Chronic cadmium exposure is linked to bone loss, but its effect on the short-term progression of bone mineral density (BMD) in previously exposed populations is not well understood. This study aimed to investigate the association between baseline urinary cadmium (U-Cd) levels and the subsequent three-year change in BMD in a chronically exposed cohort in northwestern Thailand. We conducted a three-year longitudinal study of 393 residents (40 men, 353 women) aged 35 and older. Baseline (2019) U-Cd was the primary exposure, and BMD at the calcaneus was measured in 2019 and 2022. Dual-energy X-ray absorptiometry was used for BMD measurements and atomic absorption spectrometry for U-Cd analysis. The mean U-Cd levels in males (7.18\u2009\u00b1\u20091.35 \u03bcg\/g creatinine) were significantly higher (p\u2009&lt;\u20090.001) than in females (3.68\u2009\u00b1\u20092.13 \u03bcg\/g creatinine). This study found a statistically significant decrease in BMD in the group with the lowest U-Cd levels (&lt;2.0 \u03bcg\/g creatinine, p\u2009=\u20090.001) and in the overall sample (from 0.392\u2009\u00b1\u20090.079 \u03bcg\/g creatinine in 2019 to 0.384\u2009\u00b1\u20090.094 \u03bcg\/g creatinine in 2022, p\u2009=\u20090.004). However, no statistically significant changes were observed in groups with U-Cd levels above 2.0 \u03bcg\/g creatinine. Osteoporosis prevalence remained stable in both males and females. The Linear Mixed-Effects Model analysis revealed significant associations between BMD and several factors: increasing age, female sex, diabetes status and BMI. Age and female sex were negatively associated with BMD, while BMI showed a positive relationship. U-Cd levels were not significantly associated with BMD changes over the three-year period (coefficient\u2009=\u2009\u22120.002, p\u2009=\u20090.073), though a slight downward trend in BMD was observed across all cadmium exposure levels. This study underscores the complexity of cadmium\u2019s effects on bone health and emphasizes the need for longer-term follow-up studies to better understand the potential cumulative impact of cadmium exposure on BMD.<\/jats:p>","DOI":"10.1371\/journal.pone.0334521","type":"journal-article","created":{"date-parts":[[2025,10,22]],"date-time":"2025-10-22T17:32:10Z","timestamp":1761154330000},"page":"e0334521","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["Three-year assessment of cadmium exposure and bone mineral density changes in cadmium-contaminated areas in northwestern Thailand"],"prefix":"10.1371","volume":"20","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2036-6494","authenticated-orcid":true,"given":"Aroon","family":"La-up","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6102-168X","authenticated-orcid":true,"given":"Udomsak","family":"Saengow","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tawisa","family":"Umpong","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Phuwasin","family":"Buakate","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mondhakarn","family":"Oprasertsawat","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"340","published-online":{"date-parts":[[2025,10,22]]},"reference":[{"issue":"1","key":"pone.0334521.ref001","doi-asserted-by":"crossref","first-page":"153","DOI":"10.1007\/s00204-024-03903-2","article-title":"Heavy metals: toxicity and human health effects","volume":"99","author":"K Jomova","year":"2025","journal-title":"Arch Toxicol"},{"issue":"1","key":"pone.0334521.ref002","doi-asserted-by":"crossref","DOI":"10.5620\/eaht.2021003","article-title":"Developmental toxicity of cadmium in infants and children: a review","volume":"36","author":"L Chandravanshi","year":"2021","journal-title":"Environ Anal Health Toxicol"},{"issue":"11","key":"pone.0334521.ref003","doi-asserted-by":"crossref","first-page":"3782","DOI":"10.3390\/ijerph17113782","article-title":"The Effects of Cadmium Toxicity","volume":"17","author":"G Genchi","year":"2020","journal-title":"Int J Environ Res Public Health"},{"issue":"4","key":"pone.0334521.ref004","doi-asserted-by":"crossref","first-page":"732","DOI":"10.1002\/jbmr.2743","article-title":"Low-Level Cadmium Exposure Is Associated With Decreased Bone Mineral Density and Increased Risk of Incident Fractures in Elderly Men: The MrOS Sweden Study","volume":"31","author":"M Wallin","year":"2016","journal-title":"J Bone Miner Res"},{"issue":"1","key":"pone.0334521.ref005","doi-asserted-by":"crossref","first-page":"669","DOI":"10.1186\/s13018-021-02821-8","article-title":"Global prevalence of osteoporosis among the world older adults: a comprehensive systematic review and meta-analysis","volume":"16","author":"N Salari","year":"2021","journal-title":"J Orthop Surg Res"},{"issue":"5","key":"pone.0334521.ref006","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0303418","article-title":"Associations between co\u2011exposure to heavy metals and vertebral compression fracture, as well as femoral neck bone mineral density: A cross-sectional study from NHANES data","volume":"19","author":"X Yang","year":"2024","journal-title":"PLOS ONE"},{"key":"pone.0334521.ref007","doi-asserted-by":"crossref","first-page":"117238","DOI":"10.1016\/j.ecoenv.2024.117238","article-title":"Trends in the prevalence of osteoporosis and effects of heavy metal exposure using interpretable machine learning","volume":"286","author":"H Xiao","year":"2024","journal-title":"Ecotoxicol Environ Saf"},{"issue":"6","key":"pone.0334521.ref008","doi-asserted-by":"crossref","first-page":"311","DOI":"10.1159\/000431032","article-title":"Calcium homeostasis disruption - 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