Why smoking is bad for bone health

All of us agree that smoking is well-known as being bad for heart health, lung health, and for increasing the risk for strokes.  But there’s another part of the human body also negatively affected by smoking’s harmful fumes – bone health.

No matter what your age, smoking can rob you of good bone health.  From childhood until about the age of 30, this is considered prime time for building bone mass. During this phase of life is when the body is laying down more bone than losing bone and is critical for helping each one of us to reach our peak bone mass making our bones as strong and dense as possible.  Teenagers who take up smoking will be doing themselves a huge disservice as they will not develop maximum bone mass.  They will develop a smaller skeleton with less bone mass increasing their risk for fractures and osteoporosis as they go through life.

Smoking and osteoporosis

Cigarette smoking was identified decades ago as a risk factor for osteoporosis.  Several studies have shown a direct relationship between tobacco use and reduced bone density.  However, the impact of cigarette smoking is complicated – it can be hard to determine whether a decrease in bone density is due to smoking itself or to other risk factors common among smokers.  For instance, smokers are often 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.  Each of these factors can increase the risk of osteoporosis for many smokers apart from their tobacco use. 

According to the National Institute of Health, evidence shows that:

·      The longer you smoke and the more cigarettes your consume, the greater your risk of fracture in old age

·      Older women and men who smoke experience significant bone loss

·      Smokers who break a bone tend to take longer to heal than nonsmokers and they may experience more complications during the healing process

·      Compared with nonsmokers, women who smoke may produce less estrogen and tend to experienced menopause earlier, which may lead to increased bone loss

What makes smoking so bad for bone health?

The longer a person smokes the more damage to their bones especially when a person continues to smoke past the age of 40. Bone health is affected from the nicotine and toxins found in cigarettes in many ways:

·      Cigarette smoke generates a huge amount of free radicals.  Free radicals are unstable molecules that can damage the cells in your body.  When a person has smoked for many years, these free radicals will have had plenty of time to attack and overwhelm the body’s natural defenses. The result is a chain-reaction of damage throughout the body including cells, organs, and hormones involved in keeping bones healthy.

·      Smoking triggers other bone-damaging changes such as increased levels of the hormone cortisol, which leads to bone breakdown.  Research also suggests that smoking impedes the hormone calcitonin, which helps build bone.

·      Nicotine, the toxic colorless or yellowish oily liquid that is the chief active constituent of tobacco, kills the osteoblasts which are cells that secrete matrix for bone formation.

·      Smoking damages blood vessels causing damage to nerves found in the extremities such as toes and feet.  When those nerves become damaged, this can increase the risk for falls and fractures.

·      Smoking reduces the amount of calcium your bones absorb.  Vitamin D helps bones to absorb calcium, but smoking interferes with how your body uses vitamin D.  Less calcium is then available to build strong bones which leads to weak, brittle bones. 

·      Smoking lowers levels of estrogen in both men and women.  Estrogen is important because it helps bones to hold calcium and other minerals that make them strong. At menopause, a woman’s body makes much less estrogen, and this puts her naturally at risk for osteoporosis. 

·      People who smoke tend to exercise less than nonsmokers.  In order for bones to hold calcium, it requires help from weight-bearing exercise, such as lifting weights or walking. 

·      Smoking past the age of 30 speeds up the loss of bone mass of up to 1.5 to 2 times faster.  The whole body will lose bone mass but the hip, spine, and wrist are the most affected.

Even if a person does not smoke but is regularly exposed to second-hand smoke, they are at the same risk of developing weak, brittle bones or osteoporosis as someone who does. 

Does quitting smoking help bones?

One of the best things each of us can do to protect our bones is to never take up smoking.  For anyone who currently does smoke cigarettes, the sooner you can quit smoking, the more it can help limit smoking-related bone loss.

If you’re a former smoker, leading a bone-healthy lifestyle is essential.  This includes eating a well-balanced diet rich in calcium and vitamin D; regular weight-bearing exercise; and avoiding excessive alcohol use.  You should also talk to your doctor about bone health and request a bone density test. A bone density test together with a FRAX risk assessment will help detect osteoporosis before a fracture occurs and can predict one’s chances of fracturing in the future.  These same tests can help your doctor determine whether osteoporosis medication should be prescribed.