Why It's Important to Quit
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Smoking and Osteoporosis 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. Significant bone loss has been found in postmenopausal women with prolonged smoking exposure. In addition, a relationship between cigarette smoking and low bone density in adolescence and early adulthood has been identified.
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.
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