Associations between dietary cadmium exposure and bone mineral density and risk of osteoporosis and fractures among women

► Dietary cadmium exposure can be assessed via a food frequency questionnaire. ► Low-level dietary exposure to cadmium is associated with decreased BMD and increased risk of osteoporosis and fractures. ► The adverse associations were partly masked by dietary factors of importance for bone health or cadmium bioavailability. ► Combining high dietary and high urinary cadmium decreased exposure misclassification, resulting in stronger associations between cadmium and bone. ► The findings have obvious public health relevance as elevated cadmium concentrations in cereals and vegetables are prevalent.