Young People Get Osteoporosis Too 

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Smoking and Bone Health

Many of the health consequences of tobacco use are well established. The Center for Disease Control reports that smoking-related illnesses result in nearly $50 billion in direct health care expenses each year. Cigarette smoking causes heart disease, lung and esophageal cancer, and chronic lung disease. What is less clear is the effect of tobacco use on bone density and fracture risk. While the majority of the research has implicated smoking as a risk factor for osteoporosis and fracture, some studies have failed to find an association.

Tobacco Use and Bone Density

Cigarette smoking was first identified as a risk factor for osteoporosis more than 20 years ago. Subsequent studies have also demonstrated a direct relationship between tobacco use and decreased bone density. However, not all studies have supported this finding. Though the majority of research has focused on women, studies in men have also identified smoking as a risk factor for low bone density. In a study by Vogel and associates on Japanese-American men, bone loss was greatest at sites with the higher concentrations of cancellous bone. Significant bone loss has been found in postmenopausal women and older men with prolonged smoking exposure. Deficits ranging from .5 to 1.0 standard deviations have been identified in these groups. In addition, a relationship between cigarette smoking and low bone density in adolescence and early adulthood has been identified.

Analyzing the impact of cigarette smoking on the skeleton can be difficult for several reasons. It has been suggested that differences in bone density between smokers and non-smokers may be due to concomitant lifestyle factors. For example, smokers are often thinner than their non-smoking counterparts. Smokers also tend to have a higher consumption of alcohol, may be less physically active, often have nutritional deficiencies, and tend to have an earlier menopause than non-smokers. These characteristics place many smokers at an increased risk for osteoporosis apart from their tobacco consumption.

Tobacco Use and Fracture

While the association between tobacco use and decreased bone density is fairly strong, the results are less consistent when fractures are considered. Most studies suggest at least a slight association between cigarette smoking and fracture, especially hip fracture and vertebral fracture. Not all studies have found such a relationship, however. Studies have yet to demonstrate an association between tobacco use and forearm fractures.

Cigarette Smoking and Estrogen

In an arm of the Framingham study, Kiel and colleagues found that smoking use did not increase hip fracture risk in women. Importantly, the study also concluded that while estrogen replacement protected women from fracture, this protective effect was eliminated in women on estrogen replacement who smoked. Kiel's results support an anti-estrogenic effect of cigarette smoking that is consistent with the conclusions of other researchers. For example, smokers are less likely to develop uterine cancer, fibrocystic disease and fibroadenoma. Each of these conditions is believed to be related to estrogenic stimulation. Other reports have suggested that smokers have less effective absorption of calcium, opposite to the effect of estrogen, which is believed to enhance calcium absorption.

The anti-estrogen effect of tobacco use may help explain the increased risk for osteoporosis among female smokers. Postmenopausal smokers have lower estrogen levels than non-smokers and smokers tend to have an earlier menopause than their non-smoking counterparts. This reduction in estrogen is likely to result in an increase in bone resorption, contributing to osteoporosis and fracture risk.

On a positive note, researchers have discovered that smoking cessation, even later in life, may help limit smoking-related bone loss.


Young People Get Osteoporosis Too Organization
Copyright 2001  All rights reserved.
Revised: 03/11/08.