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Osteoporosis Health Center

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Smoking and Osteoporosis

Many of the health problems caused by the use of tobacco are well known. The Centers for Disease Control and Prevention reports that smoking-related illnesses cost Americans more than $75 billion each year. Cigarette smoking causes heart disease, lung and esophageal cancer, and chronic lung disease. Additionally, several research studies have identified smoking as a risk factor for osteoporosis and bone fracture.

Facts About Osteoporosis

Osteoporosis is a condition in which bones weaken and are more likely to fracture (break). Fractures from osteoporosis can result in pain, disability, and sometimes death. Osteoporosis is a major health threat for an estimated 44 million Americans, 68 percent of whom are women. In addition to smoking, risk factors for developing osteoporosis include:
• being thin or having a small frame
• having a family history of the disease or of fractures after the age of 50
• being postmenopausal or having had an early menopause
• having an abnormal absence of menstrual periods
• using certain medications, including glucocorticoids, for a long time
• not getting enough calcium
• not getting enough physical activity
• drinking too much alcohol.
Osteoporosis can often be prevented. Osteoporosis is a “silent” disease: it can progress for many years without symptoms until a fracture occurs. It has been called “a pediatric (childhood) disease with geriatric (old age) consequences,” because building healthy bones in youth helps prevent osteoporosis and fractures later in life. However, it is never too late to adopt new habits for healthy bones.

Smoking and Osteoporosis

Cigarette smoking was first identified as a risk factor for osteoporosis more than 20 years ago. Recent studies have shown a direct relationship between tobacco use and decreased bone density. Analyzing the impact of cigarette smoking on bone
health is complicated. It is hard to determine whether a decrease in bone density is due to smoking itself or to other risk factors common among smokers. For example, in many cases smokers are thinner than nonsmokers, tend to drink more alcohol, may be less physically active, and have poor diets. Women who smoke also tend to have an earlier menopause than nonsmokers. These factors place many smokers at an increased risk for osteoporosis apart from their tobacco use.


In addition, most studies on the effects of smoking suggest that smoking increases the risk of having a fracture. Not all studies have supported these findings, but the evidence is mounting. For example:

• The longer you smoke and the more cigarettes you consume, the greater your risk of fracture in old age.
• Smokers who fracture may take longer to heal than nonsmokers and may experience more complications during the healing process.
• Significant bone loss has been found in older women and men who smoke.
• At least one study suggests that exposure to second-hand smoke during youth and early adulthood may increase the risk of developing low bone mass.
• Women who smoke often produce less estrogen (a sex hormone) and tend to experience menopause earlier than nonsmokers, which may lead to increased bone loss.
• Quitting smoking appears to reduce the risk of low bone mass and fractures. However, it may take several years to lower a former smokers risk.

WebMD Public Information from the U.S. National Institutes of Health

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