Smoking

For a downloadable fact sheet click Smoking and Your Bones

Can smoking harm my bones?

It is alarming that approximately 1 in 8 hip fractures (broken hips) in women are caused by long-term cigarette use (more than 1 pack a day for more then 5 years) or current use of tobacco products. Smoking is also a major risk factor for hip fracture in men. In addition, the healing process following hip fracture is slower among smokers than non-smokers.

How does smoking harm my bones?

More research is needed to fully understand the mechanism of the action of smoking on bone. However, it appears that smoking has direct toxic effects on the cells that make bone called osteoblasts. There are also certain factors associated with smoking that may contribute to increased bone loss and lower bone mass. A healthy body weight and weight-bearing exercise are important to build bone mass in youth and maintain it in adulthood. However, smokers tend to be thinner and exercise less than non-smokers resulting in less weight bearing on their bones. In addition, smoking reduces estrogen levels in women, the female hormone that protects the bones. Women who smoke often experience an earlier menopause (the permanent loss of menstrual periods) than non-smokers. An earlier menopause results in a woman having a longer period of time without estrogen.

How does smoking affect my bones over a lifetime?

Smoking during the growing years can prevent you from reaching your peak bone mass. Peak bone mass, defined as the maximum bone density (thickness) you will ever have, is reached between 18 and 25 years of age. It is a wise choice not to smoke during youth and young adulthood because if you build larger and heavier bones; you are less likely to develop osteoporosis later in life. At menopause, most women lose bone mass rapidly and smoking will lead to even greater losses. Smoking may also decrease the effectiveness of estrogen therapy or hormone replacement therapy in preventing bone loss. The age-related bone loss that occurs later in life in both men and women also appears to be accelerated among smokers.

Individuals with a history of smoking more than 1 pack of cigarettes per day for more than 5 years or those who currently smoke are at risk for osteoporosis. Heavier smokers have lower bone density and a higher risk for fracture than nonsmokers or light smokers. In addition, current cigarette smoking is an independent risk factor for hip fracture; that means smokers are at an increased risk for hip fracture even when their bone density is normal. A hip fracture is a debilitating bone break that tends to occur in the senior years and is more common among smokers. Men tend to have greater problems than women after suffering a hip fracture. The likelihood that a man will return to the fully independent lifestyle he had prior to a hip fracture is lower than it is for a woman. In fact, men are at greater risk of dying in the year following a hip fracture than are women.

What can a smoker do to reduce the risk for osteoporosis?

1. Quit smoking! If you are a smoker and decide to continue to smoke, you are clearly taking the chance of developing osteoporosis and may be increasing your risk for fracture. The good news is that the sooner you quit smoking, the better. Quitting smoking is an important way to reduce your fracture risk. For example, women who stop smoking can cut their hip fracture risk in half after only 5 years.For more information about how you can quit smoking or using tobacco products;call Smoker's Quitline at 1-866-697-8487 (1-866-NY-QUITS)or click on The New York State Smoker's Quitsite  http://www.nysmokefree.com/ 
2. If you are a smoker don't let osteoporosis sneak up on you, find out if a bone mineral density test (BMD test) is appropriate for you. A BMD test can measure the density of your bones and detect osteoporosis before a bone breaks. Smoking is such an important risk factor for osteoporosis that women who currently smoke or have a recent history of smoking more than 1 pack per day should have a BMD test at the time of menopause. Men who are current or long-term smokers should speak to their medical professional to find out when a BMD test is recommended.

3. It is important to assess your other risk factors for osteoporosis (besides smoking) by using the appropriate NYSOPEP Osteoporosis Risk Assessments. See "Osteoporosis Risk Assessment for Postmenopausal Women", for "Premenopausal Women" or "for Men". Completion of an osteoporosis risk assessment will help you identify your risk factors so that you can easily discuss the ways to reduce your risks and optimize your bone health with your healthcare provider.
   

4. Ideally, you should begin bone healthy actions in childhood and continue them throughout your lifetime. It's never too early or too late to take the actions to promote strong bones.

   What are the actions that promote strong bones?

   In addition to not smoking, the following actions can help build strong bones in youth and maintain bone mass in adulthood:

   • Eat a nutrient-rich diet including adequate calcium and get the recommended amount of vitamin D.
   • Get moving! Participate in regular physical activity. An ideal regimen includes weight-bearing, muscle strengthening, postural and balance exercises
   • Limit alcohol intake; avoid heavy and underage drinking
   • Avoid excessive dieting and excessive thinness
   • Consult your healthcare provider to determine and treat the cause if you are a premenopausal woman with irregular menstrual periods
   • Taking safety precautions to protect your bones and prevent falls

   What if I am diagnosed with osteoporosis?

   Treatment of osteoporosis should always include the actions to promote strong bones. However, when osteoporosis is diagnosed, these important steps are usually not enough. Medication may be needed to stop further bone loss or to prevent fractures. For more information see "FDA-Approved Medications for Osteoporosis Prevention and/or Treatment".