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
• 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
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
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
• 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.