Smoking and Osteoporosis: How Smoking Affects Osteoporosis

Many of the health problems caused by the use of tobacco are well known. Smoking causes:

heart disease

lung cancer

esophageal cancer

chronic lung disease

Several research studies have also identified smoking as a risk factor for osteoporosis and bone fractures.

Facts About Osteoporosis

Osteoporosis is a condition in which bones weaken and are more likely to fracture. Fractures from osteoporosis can result in pain, disability, and sometimes death. Osteoporosis is a major health threat for an estimated 44 million Americans, 68% are women.

In addition to smoking, osteoporosis risk factors 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 drugs, including corticosteroids, 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 childhood disease with 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. 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 support these findings, but 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

significant bone loss has been found in older women and men who smoke

studies suggests second-hand smoke exposure during youth may increase the risk of developing low bone mass

women who smoke often produce less estrogen and tend to experience menopause earlier than nonsmokers

quitting smoking appears to reduce the risk of low bone mass and fractures

Osteoporosis Management Strategies

Start by quitting:

The best thing a smoker can do to protect his or her bones is to quit smoking. Smoking cessation, even later in life, may help limit smoking-related bone loss.

Eat a well-balanced diet rich in calcium and vitamin D:

Good sources of calcium include:

low-fat dairy products

dark green leafy vegetables

calcium-fortified foods and beverages

Calcium supplements can help ensure that you get adequate amounts of calcium each day. The Institute of Medicine recommends a daily calcium intake of 1,000 mg (milligrams) for men and women, increasing to 1,200 mg for those over age 50.

Vitamin D plays an important role in calcium absorption and bone health. Vitamin D can be obtained naturally through exposure to sunlight and through various foods and supplements. Food sources of vitamin D include:

egg yolks

saltwater fish

liver

Some people may need vitamin D supplements to achieve the recommended intake of 400 to 800 IU each day.

Exercise for your bone health:

Like muscle, bone is living tissue that responds to exercise by becoming stronger. Weight-bearing exercise that forces you to work against gravity is the best exercise for bone.

Many arthritis-friendly exercises such as walking may help prevent bone loss and provide other health benefits.

Avoid excessive use of alcohol:

Chronic alcohol use has been linked to an increase in fractures of the hip, spine, and wrist. Too much alcohol interferes with the balance of calcium in the body. It also affects the production of hormones, which have a protective effect on bone; and of vitamins, which we need to absorb calcium. Excessive alcohol use can also lead to slips and falls.

Talk to your doctor about a bone density test:

Bone mineral density (BMD) tests measure bone density in various sites of the body. These tests can detect osteoporosis before a fracture occurs and can predict your chances of fracturing in the future.

Use of osteoporosis drugs:

There are now several osteoporosis medications available for osteoporosis prevention and treatment.

Related Resources

Osteoporosis

Smoking & Arthritis

Osteoporosis Screening Quiz

_{Source: NIAMS, Smoking and Bone Health, Rev. April 2005}