Tobacco and osteoporosis
As populations age the world over, osteoporosis or loss of bone mineral density, will generate an increasing burden of disease. Far more common among women than men, osteoporosis itself is less a disease than a risk factor because people with osteoporosis have much higher risk of fractures, particularly of the hip and vertebral bodies.
Hip fractures, while surgically repairable, often cause substantial disability and may prevent someone from returning home even after rehabilitation if their home is unsuitable for someone with impaired mobility. In even the most resource-rich health care systems, the resources that will be consumed by treatment and care of such fractures is expected to grow exponentially.
The strongest evidence of the effects of smoking in decreasing bone mineral density comes from a meta-analysis which considered 29 studies and concluded that roughly one in eight hip fractures is attributable to cigarette smoking. Current smokers lose bone at faster rates than non-smokers, and by age 80 this can translate into 6% lower bone mineral density. Hip fracture risk among smokers is greater at all ages but rises from 17% greater at age 60 to 71% at age 80 and 108% at age 901.
Risks are lower in former smokers, suggesting a benefit of quitting smoking in slowing the rate of bone loss.
(1) Law MR, Hackshaw AK. A meta-analysis of cigarette smoking, bone mineral density and risk of hip fracture: recognition of a major effect. BMJ 1997; 315:841-6.