Smoking, smoking cessation, and fracture risk in elderly women followed for 10 years

Thorin, Mats H; Wihlborg, Axel; Åkesson, Kristina; Gerdhem, Paul

doi:10.1007/s00198-015-3290-z

Cited by 61 publications

(41 citation statements)

References 39 publications

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“…This study, by use of genetic instruments, strengthens the causal inference on an association between smoking and higher fracture risk. Accordingly, by more firm scientific support, reducing cigarette smoking initiation and smoking cessation, considering the reversible risk of smoking on fracture risk [38,39], can now be even more strongly recommended for fracture prevention. No associations were observed between genetically predicted alcohol and coffee intake and fracture or BMD, but there was evidence that alcohol dependence may be a risk factor for fracture.…”

Section: Resultsmentioning

confidence: 99%

Associations of Smoking and Alcohol and Coffee Intake with Fracture and Bone Mineral Density: A Mendelian Randomization Study

et al. 2019

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The causal associations of smoking and alcohol and coffee intake with fracture and bone mineral density are unknown. We investigated the associations using Mendelian randomization (MR). Summary-level data from UK Biobank for bone fractures (main outcome) (53,184 cases; 373,611 non-cases) and estimated bone mineral density (eBMD) (n = 426,824 individuals) were used. Single-nucleotide polymorphisms associated with smoking initiation (n = 378) and alcohol (n = 99) and coffee (n = 15) intake at the genome-wide significance threshold (P = 5 × 10 −8) were identified from published genome-wide association studies. Univariable and multivariable inverse-variance weighted, weighted median, MR-Egger, and MR-PRESSO methods were used for statistical analyses. Genetic predisposition to smoking initiation was associated with fracture but not eBMD. The odds ratio of fracture per one-unit increase in log odds of smoking was 1.09 (95% confidence interval 1.04, 1.15; P = 8.58 × 10 −4) after adjustment for alcohol intake in the multivariable MR analysis. The association remained in complementary analyses. Genetically predicted alcohol and coffee intake was not associated with fracture or eBMD. Nevertheless, genetic liability to alcohol dependence, based on variants in the ALD1B gene, was associated with fracture and lower eBMD. The odds ratio was 1.06 (95% confidence interval 1.01, 1.12; P = 0.018) per genetically predicted one-unit higher log odds of liability to alcohol dependence. This MR study strengthens the causal inference on an association between smoking and higher fracture risk but found no linear association of modestly higher alcohol and coffee intake with fracture or BMD. However, alcohol dependence may increase fracture risk. Keywords Alcohol • Bone mineral density • Coffee • Fracture • Mendelian randomization • Smoking Abbreviations BMD Bone mineral density BMI Body mass index CI Confidence interval DXA Dual-energy X-ray absorptiometry eBMD Estimated bone mineral density MR Mendelian randomization OR Odds ratio SNPs Single-nucleotide polymorphisms Electronic supplementary material The online version of this article (

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Section: Resultsmentioning

confidence: 99%

Associations of Smoking and Alcohol and Coffee Intake with Fracture and Bone Mineral Density: A Mendelian Randomization Study

et al. 2019

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“…Reduced smoking is associated with a suppressed incidence of fractures [43], especially in the vertebral column [43, 81] and reduced prevalence of periodontal disease [82]. Smoking is the most detrimental modifiable risk factor that should be pro-actively managed [83].…”

Section: Interdisciplinary Management Of Osteoporosis and Periodontitismentioning

confidence: 99%

Osteoporosis and Periodontitis

Wang

McCauley

2016

Curr Osteoporos Rep

158

124

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Osteoporosis and periodontitis are both diseases characterized by bone resorption. Osteoporosis features systemic degenerative bone loss that leads to loss of skeletal cancellous microstructure and subsequent fracture, whereas periodontitis involves local inflammatory bone loss, following an infectious breach of the alveolar cortical bone, and it may result in tooth loss. Most cross-sectional studies have confirmed the association of osteoporosis and periodontitis primarily on radiographic measurements and to a lesser degree on clinical parameters. Multiple shared risk factors include age, genetics, hormonal change, smoking, as well as calcium and vitamin D deficiency. Both diseases could also be risk factors for each other and have a mutual impact that requires concomitant management. Suggested mechanisms underlying the linkage are disruption of the homeostasis concerning bone remodeling, hormonal balance, and inflammation resolution. A mutual interventional approach is emerging with complex treatment interactions. Prevention and management of both diseases require interdisciplinary approaches and warrants future well-controlled longitudinal and interventional studies for evidence-based clinical guidelines.

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“…Our participants had a significant smoking history (46 pack-years for the COPD group, 32 for the smokers), indicating that smoking rather than COPD is a major risk factor for VFs. (11,38,39) In a group of 90 COPD patients (69 AE 1 years old, 60% male), Graat-Verboom et al (32) showed an increase of prevalent VFs from 32% to 52% within three years (63% increase). In our study population, prevalence of VFs increased from 20.4% at baseline to 24.5% at 1-year and 32.4% at 3-year follow-up (59% increase), indicating a similar increase.…”

Section: Comparison To Published Researchmentioning

confidence: 99%

“…(32) However, the incidence of clinical VFs in subjects with COPD was as low as 1.3/1000 person-years (35) to 6% over 2.6 years (36) and 0.5% to 1.0% within 3 years. (37) Smokers without COPD have lower BMD, (38) an increased risk of VFs, (11,24,34,38,39) and an increased risk of any osteoporotic fracture. (10,39) The prevalence of radiographic VFs in smokers as reported in the literature varied between 11% and 24%, (34,38) whereas incidence of clinical VFs varied from 3% (40) (30-year follow-up) to 26% (39) (10-year follow-up).…”

Section: Introductionmentioning

confidence: 99%

“…(37) Smokers without COPD have lower BMD, (38) an increased risk of VFs, (11,24,34,38,39) and an increased risk of any osteoporotic fracture. (10,39) The prevalence of radiographic VFs in smokers as reported in the literature varied between 11% and 24%, (34,38) whereas incidence of clinical VFs varied from 3% (40) (30-year follow-up) to 26% (39) (10-year follow-up). VFs are associated with height loss, (41) less activities in daily living, (41) and increased mortality risk.…”

Section: Introductionmentioning

confidence: 99%

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High Imminent Vertebral Fracture Risk in Subjects With COPD With a Prevalent or Incident Vertebral Fracture

Dort

Geusens

Driessen

et al. 2018

Journal of Bone and Mineral Research

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Subjects with chronic obstructive pulmonary disease (COPD) have an increased risk of vertebral fractures (VFs); however, VF incidence is largely unknown. Therefore, the aim of our study was to determine the incidence of new and/or worsening VF in subjects with COPD. Smokers and subjects with COPD (GOLD II-IV) from the ECLIPSE study with complete set of chest CT scans (baseline and 1-and 3-year follow-up) to evaluate vertebrae T 1 down to L 1 were included. If a VF was diagnosed on the last scan, detailed VF assessment of the previous scans was performed. VFs were scored according to the method of Genant as mild, moderate, or severe. Main outcome measure was the cumulative incidence of new and/or worsening VF at subject level, within 1 and 3 years. Of 1239 subjects (mean age 61 years, 757 males [61%], 999 subjects with COPD), 253 (20.5%) had !1 prevalent VF. The cumulative incidence of VFs was 10.1% within 1 year and 24.0% within 3 years. After adjustment for age, sex, body mass index (BMI), pack-years, and smoking status, prevalence and incidence were similar between smokers and COPD GOLD stages. Within 1 year, 29.2% of the subjects with a prevalent VF had an incident VF, compared with 5.1% in absence of prevalent VF (hazard ratio [HR] ¼ 5.1; 95% confidence interval [CI] 3.6-7.4) and 58.5% versus 15.0% within 3 years (HR ¼ 3.6; 95% CI 2.9-4.6). The incidence of VF was higher with increasing number and severity of prevalent VFs. Among subjects having an incident VF within the first year, 57.3% had a subsequent VF within the next 2 years. In this study, more than half of the smokers and subjects with COPD with a prevalent VF or an incident VF within the first year sustained a subsequent VF within 3 years. The 3-year risk was even higher in the presence of multiple or severe prevalent VFs.

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Smoking, smoking cessation, and fracture risk in elderly women followed for 10 years

Abstract: Smoking increased the risk for fracture among elderly women, especially vertebral fractures. Smoking cessation decreased the risk for vertebral fractures but not for other types of fractures.

Cited by 61 publications

References 39 publications

Associations of Smoking and Alcohol and Coffee Intake with Fracture and Bone Mineral Density: A Mendelian Randomization Study

Associations of Smoking and Alcohol and Coffee Intake with Fracture and Bone Mineral Density: A Mendelian Randomization Study

Osteoporosis and Periodontitis

High Imminent Vertebral Fracture Risk in Subjects With COPD With a Prevalent or Incident Vertebral Fracture

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