Associations between multiple metals exposure and bone mineral density: a population-based study in U.S. children and adolescents.

AIM: This study examined the correlation between multi-metal exposure and bone mineral density (BMD) in U.S. children and adolescents.

METHODS

Data from 1,591 participants (aged 8-19) were analyzed using the National Health and Nutrition Examination Survey (NHANES) 2011-2016. We measured serum copper (Cu), selenium (Se), zinc (Zn), and blood lead (Pb), cadmium (Cd), mercury (Hg), manganese (Mn). Dual-energy X-ray absorptiometry assessed lumbar and total BMD. Advanced statistical approaches including weighted quantile sum (WQS) regression and bayesian kernel machine regression (BKMR) were employed to evaluate complex exposure interactions.

RESULTS

Blood Pb and serum Cu showed inverse associations with, while serum Se positively correlated with lumbar BMD (blood Pb: β: -0.013, serum Cu: β: -0.063, serum Se: 0.035) (all P < 0.05). The WQS index showed a significant association with both lumbar BMD(β = 0.019, P < 0.05) and total BMD (β = 0.019, P < 0.001). WQS analysis identified Cd, Se, and Hg as primary contributors to both lumbar and total BMD variations. BKMR models revealed nonlinear exposure-response relationships and synergistic effects between Cd and Mn.

CONCLUSION

These findings highlight the importance of considering mixed metal exposures in bone health assessments, providing crucial insights for developing preventive strategies to protect skeletal development in pediatric populations.