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Environmental exposure to metals has been proposed as a potential contributor to osteoporosis, but human data remain limited and inconsistent. This study investigated changes in urinary concentrations of 20 metal(loid)s in patients with osteoporosis, as well as the association of these elements with bone mineral density (BMD), in a cohort of 380 postmenopausal women aged 50\u201370 years from Cascavel, Paran\u00e1, Brazil. Demographic, lifestyle, and clinical data were collected, and urinary concentrations of aluminum (Al), barium (Ba), cadmium (Cd), cobalt (Co), cesium (Cs), copper (Cu), mercury (Hg), lithium (Li), manganese (Mn), molybdenum (Mo), nickel (Ni), lead (Pb), rubidium (Rb), antimony (Sb), selenium (Se), tin (Sn), strontium (Sr), thallium (Tl), uranium (U), and zinc (Zn) were measured by inductively coupled plasma mass spectrometry. BMD was assessed at the lumbar spine, femoral neck, and total hip using dual-energy X-ray absorptiometry. Osteoporosis was diagnosed in 73 participants (19.2%). Osteoporotic women had significantly higher urinary concentrations of Cd, Mn, Pb, Sb, Sn, and Zn (p &lt; 0.05). Statistically significant negative correlations were observed between BMD and urinary concentrations of Al, Cd, Hg, Mn, Sb, and U. After adjustment for confounders, elevated urinary concentrations of Cd, Mn, Pb, and Sb remained independently and significantly associated with higher odds of osteoporosis, with Cd (aOR = 1.495; p = 0.026) and Sb (aOR = 2.059; p = 0.030) showing the strongest associations. In addition, women with urinary concentrations above the 90th percentile for both Cd and Sb had a significantly higher prevalence of osteoporosis compared to those with lower levels (44.4% vs. 18.0%; p = 0.011). Longitudinal studies are needed to confirm causality and inform prevention strategies.<\/jats:p>","DOI":"10.3390\/toxics13060489","type":"journal-article","created":{"date-parts":[[2025,6,10]],"date-time":"2025-06-10T09:59:14Z","timestamp":1749549554000},"page":"489","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Association of Urinary Cadmium and Antimony with Osteoporosis Risk in Postmenopausal Brazilian Women: Insights from a 20 Metal(loid) Biomonitoring Study"],"prefix":"10.3390","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0009-0004-2478-1929","authenticated-orcid":false,"given":"Carlos Tadashi","family":"Kunioka","sequence":"first","affiliation":[{"name":"FP-I3ID, FP-BHS, Fernando Pessoa University, Pra\u00e7a de 9 de Abril 349, 4249-004 Porto, Portugal"},{"name":"Western Paran\u00e1 State University (UNIOESTE), Cascavel 85819-110, PR, Brazil"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2725-5586","authenticated-orcid":false,"given":"Vanessa Cristina","family":"de Oliveira Souza","sequence":"additional","affiliation":[{"name":"Department of Clinical Analyses, Toxicology and Food Sciences, School of Pharmaceutical Sciences of Ribeirao Preto, University of Sao Paulo, Ribeir\u00e3o Preto 14040-903, SP, Brazil"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7893-758X","authenticated-orcid":false,"given":"Bruno Alves","family":"Rocha","sequence":"additional","affiliation":[{"name":"Department of Clinical Analyses, Toxicology and Food Sciences, School of Pharmaceutical Sciences of Ribeirao Preto, University of Sao Paulo, Ribeir\u00e3o Preto 14040-903, SP, Brazil"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2498-0619","authenticated-orcid":false,"given":"Fernando Barbosa","family":"J\u00fanior","sequence":"additional","affiliation":[{"name":"Department of Clinical Analyses, Toxicology and Food Sciences, School of Pharmaceutical Sciences of Ribeirao Preto, University of Sao Paulo, Ribeir\u00e3o Preto 14040-903, SP, Brazil"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3941-6850","authenticated-orcid":false,"given":"Lu\u00eds","family":"Belo","sequence":"additional","affiliation":[{"name":"UCIBIO i4HB, Faculty of Pharmacy, University of Porto, Rua Jorge Viterbo Ferreira 228, 4050-313 Porto, Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1774-1337","authenticated-orcid":false,"given":"Maria Concei\u00e7\u00e3o","family":"Manso","sequence":"additional","affiliation":[{"name":"FP-I3ID, FP-BHS, Fernando Pessoa University, Pra\u00e7a de 9 de Abril 349, 4249-004 Porto, Portugal"},{"name":"LAQV\/REQUIMTE, University of Porto, 4050-313 Porto, Portugal"},{"name":"RISE-Health, Faculty of Health Sciences, Fernando Pessoa University, Fernando Pessoa Teaching and Culture Foundation, Rua Carlos da Maia 296, 4200-150 Porto, Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9884-4751","authenticated-orcid":false,"given":"M\u00e1rcia","family":"Carvalho","sequence":"additional","affiliation":[{"name":"FP-I3ID, FP-BHS, Fernando Pessoa University, Pra\u00e7a de 9 de Abril 349, 4249-004 Porto, Portugal"},{"name":"LAQV\/REQUIMTE, University of Porto, 4050-313 Porto, Portugal"},{"name":"RISE-Health, Faculty of Health Sciences, Fernando Pessoa University, Fernando Pessoa Teaching and Culture Foundation, Rua Carlos da Maia 296, 4200-150 Porto, Portugal"}]}],"member":"1968","published-online":{"date-parts":[[2025,6,10]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Dong, Y., Kang, H., Peng, R., Song, K., Guo, Q., Guan, H., Zhu, M., Ye, D., and Li, F. 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