Impact of Cigarette Smoking on the Risk of Osteoporosis in Inflammatory Bowel Diseases

Abstract

Cigarette smoking constitutes one of the most important modifiable factors of osteoporosis, as well as contributes to an early death, tumors, and numerous chronic diseases. The group with an increased risk of a lower bone mineral density are patients suffering from inflammatory bowel diseases. In fact, tobacco smoke, which contains more than 7000 chemical compounds, affects bone mineral density (BMD) both directly and indirectly, as it has an impact on the RANK-RANKL-OPG pathway, intestinal microbiota composition, and calcium–phosphate balance. Constant cigarette use interferes with the production of protective mucus and inhibits the repair processes in the intestinal mucus. Nicotine as well as the other compounds of the cigarette smoke are important risk factors of the inflammatory bowel disease and osteoporosis. Additionally, cigarette smoking may decrease BMD in the IBD patients. Interestingly, it affects patients with Crohn’s disease and ulcerative colitis in different ways—on the one hand it protects against ulcerative colitis, whereas on the other it increases the risk of Crohn’s disease development. Nevertheless, all patients should be encouraged to cease smoking in order to decrease the risk of developing other disorders.

Impact of the host response and osteoblast lineage cells on periodontal disease

“…This may be due to increased production of ROS and reduced expression of antioxidants ( 174 ). Smoking may also promote bone resorption by increasing the RANKL/OPG ratio ( 172 , 175 , 176 ). However, the effect of tobacco smoke on cytokine levels has been inconclusive ( 171 , 177 , 178 ).…”

Bone Fragility in Gastrointestinal Disorders

“…development [29]. As already mentioned, the RANK-RANKL-OPG pathway is considered a key element of osteoporosis pathogenesis among patients suffering from IBD [30].…”

“…In humans, numerous risk factors for the development of bone fragility in IBD have been suggested, such as genetic factors, malnutrition or impaired absorption of nutrients, calcium and vitamin D deficiency, sex hormone deficiency, a dysbiotic intestinal microbiome, and pharmacotherapy, particularly glucocorticoid therapy, which have to be considered in the management of such patients [ 26 , 27 , 28 ]. Among other risk factors for osteoporosis, it is well known that cigarette smoking induces oxidative stress, which may play an important role in IBD [ 29 ]. Likewise, nicotine and chemical compounds within tobacco smoke may impair bone quality, both directly and indirectly, modulating the receptor activator of the nuclear factor–kappa B (RANK)–receptor activator for the nuclear factor–kappa B ligand (RANKL)–osteoprotegerin (OPG) pathway (the master regulator of osteoclast activity and bone resorption), intestinal microbiota composition, and calcium-phosphate balance.…”

“…Moreover, constant cigarette use interferes with the production of the protective mucus and inhibits the repair processes in the intestine, thus leading to impaired absorption of nutrients. Interestingly, smoking might affect patients with CD and UC in different ways; it seems to protect against UC, whereas, on the other hand, it increases the risk of CD development [ 29 ]. As already mentioned, the RANK–RANKL–OPG pathway is considered a key element of osteoporosis pathogenesis among patients suffering from IBD [ 30 ].…”

Evaluation of an Ionic Calcium Fiber Supplement and Its Impact on Bone Health Preservation in a Dietary Calcium Deficiency Mice Model

“…Genetic, glucocorticoid treatments, and environmental aspects impact bone turnover in women, men, children, and adolescents [ 15 , 16 ]. Typically, pharmacological treatments against osteoporosis are based on calcium and vitamin D supplementation, antiresorptive agents (such as bisphosphonates, calcitonin, or denosumab), or anabolic drugs (teriparatide) [ 12 , 17 ]. Despite the differences between human metabolism and animal metabolism, animal models continue to be employed to understand the impact of new products that promote health in a short time.…”