Abstract
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.