Bone lead as a new biologic marker of lead dose: Recent findings and implications for public health

Measurements of lead in bone have recently become the focus of research because a) bone lead levels serve as a cumulative dosimeter of lead exposure over many years (because of lead's long residence time in bone), and cumulative exposure may be more predictive of chronic toxicity than recent exposure, which is what blood lead levels mostly reflect; b) there is suspicion that heightened bone turnover (e.g., during pregnancy, lactation, and aging) may liberate enough stored lead to pose a significant threat of delayed toxicity; and c) although lead exposure has largely declined in the United States over the past 10 to 15 years, decades of heavy environmental pollution have resulted in significant accumulation of lead in bone among most members of the general U.S. population. Epidemiologic research on the impact of lead stored in bone is now possible with the development of Cd-109 K-X-ray fluorescence (KXRF) instruments for the in vivo measurement of lead in bone. In this paper, the KXRF method will be briefly reviewed, followed by a summary of several Superfund-supported studies land others) of blood lead and KXRF-measured bone lead in which these measures are compared as biologic markers of lead dose. Measurement of bone lead in epidemiologic studies has proved useful in exposure assessment studies, i.e., in identifying factors that contribute most to retained body lead burden, and in investigating cumulative lead exposure as a risk factor for poor health outcomes such as hypertension, kidney impairment, cognitive impairment, behavioral disturbances, and adverse reproductive outcomes.