Differences in the susceptibility to cadmium-induced renal tubular damage and osteoporosis according to sex

• We estimated the risks for renal tubular damage and osteoporosis by Cd exposure according to the sex.
• Increased Cd body burden directly decreases the BMD in male subjects.
• In female subjects, increased Cd body burden first induces renal microtubular damage and then leads to osteoporosis.

This study aimed to estimate the risks for renal tubular damage and osteoporosis in individuals with long-term environmental Cd exposure. This cross-sectional study comprised 1086 residents living in the vicinity of a copper refinery plant. As the urinary Cd levels increased, the proportion of female subjects with β2-MG ≥300 μg/g creatinine also increased significantly, but this was not observed in the male subjects. The prevalence of osteoporosis was significantly higher in men with urinary Cd >5 μg/g creatinine than in those with urinary Cd ≤5 μg/g creatinine. This difference was not observed in the corresponding female groups. The association between increased urinary excretion of β2-MG and decreased BMD was statistically significant only in the female subjects. We suggest that an increased Cd body burden directly decreases the BMD in male subjects; however, in female subjects, it first induces renal microtubular damage, which can lead to osteoporosis.