The effects of smoking on bone health

Abstract

Osteoporotic fractures are a major public health problem in most developed countries and an increasing concern in much of the developing world. This healthcare burden will increase significantly worldwide over the next 20 years due to aging of the population. Smoking is a key lifestyle risk factor for bone loss and fractures that appears to be independent of other risk factors for fracture such as age, weight, sex and menopausal status. This review discusses the effects of smoking on bone health in pre-menopausal and post-menopausal women and men. Data from twin studies and the three main published meta-analyses are presented. Possible mechanisms by which smoking affects bone mass are reviewed. Despite smoking being a major lifestyle risk factor for osteoporosis, the mechanisms underlying smoking-associated bone loss and fracture risk remain poorly understood. The effect appears dose-dependent, and may be, at least partially, reversible. However, more work is required to confirm and characterize the reversibility of smoking-associated bone defects. Finally, strategies for quitting smoking are discussed. Encouragement of lifestyle alterations, including smoking cessation, should be a major component of any bone therapeutic programme.

A review of lifestyle, smoking and other modifiable risk factors for osteoporotic fractures

“…20 Determining the independent role of smoking in decreasing bone mass is more complicated, as smoking may be correlated to other risk factors for osteoporosis such as low BMI, decreased physical activity and poor diet. 19 …”

“…It is of course a modifiable risk factor and should be appraised when assessing individual fracture risk. 19 The negative effects of smoking on cardiovascular and pulmonary function are well described, and smoking cessation remains the single most effective intervention to reduce the risk of tobacco-induced pulmonary disease such as chronic obstructive pulmonary disease (COPD) and to slow its progression. 20 Determining the independent role of smoking in decreasing bone mass is more complicated, as smoking may be correlated to other risk factors for osteoporosis such as low BMI, decreased physical activity and poor diet.…”

Body weight, BMI, and stature have a protective effect on bone mineral density in women with postmenopausal vertebral osteoporosis, whereas greater age at menarche and years after menopause have a negative effect

“…BMD was not associated with age at menopause or number of reproductive years. For multiple regressions there was an increasing trend of r 2 with increasing number of independent variables included in the analysis: r 2 = 21.84% (2 variables), r 2 = 24.93% (3 variables), 26.45% (4 variables), and r 2 = 27% (5 variables). Conclusion: BMD is positively associated with weight, BMI, and stature, and is negatively associated with age, time of menarche, and years after menopause.…”

Influence of cigarette smoking on bone mineral density in postmenopausal women with estrogen deficiency in menstrual history

“…Th e defi cit of estrogen is associated with a decrease in bone mass, but healthy lifestyle (no smoking) has the potential to preserve bone mass in postmenopausal women with estrogen defi ciency in their menstrual history. Encouragement of lifestyle alterations, including smoking cessation, should be a major component of any bone therapeutic programme (21).…”