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Tobacco May Be Causing Your Osteoporosis

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Tobacco smoke has been rigorously proven to cause cancers and poor lung functions but it actually affects all the organs of the body including the bone. Studies have confirmed that smoking raises the risk of osteoporotic fractures especially among men and postmenopausal women. Unfortunately, it takes some years after quitting for this risk to come down. But how exactly does tobacco contribute to poor bone health? What kind of risk do smokers have with regards to osteoporosis? What else can you do besides quitting to improve your bone mass and bone strength? Read on to find out.

What’s in the Smoke?

Tobacco is known to cause more preventable deaths than any other toxic substance.

While tobacco smoke looks fleeting, scientists have identified more than 4,000 different compounds in it and at least 60 of these compounds have been confirmed as potent toxins and 45 of them are chemical carcinogens.

The toxic compounds in tobacco smoke range from amines to polycyclic hydrocarbons. These harmful substances can cause damage to any organ in the body but especially the heart, liver, and lungs.

The negative effects of tobacco depend on the source of the tobacco, how it is used and for how long it has been used. Generally, non-smokers are healthier than smokers. Because the effects of smoking are cumulative, even former smokers are not as healthy as non-smokers.

Experts estimate the smokers lose 13 – 15 years of life to tobacco smoke. The increased mortality rate among smokers is primarily due to the increased risks of different cancers, lung diseases, cardiovascular diseases, stroke, kidney problems, and infections.

In addition, tobacco use can cause infertility, impotence, and miscarriages. Smoking increases stress levels, impairs cognitive functions and raises the risks of psychological problems.

Other negative effects of tobacco use are depressed appetite, unhealthy weight loss, impaired wound healing and increased risk of bone fractures.

Smoking and Bone Health

The evidence to suggest that tobacco use is a risk factor for osteoporosis started emerging in the 1980s.

Studies show that tobacco smoke reduces bone mass especially among men and postmenopausal women.

While smoking does not seem to affect premenopausal women as much as postmenopausal women, scientists believe that this observation is simply due to the hormonal changes that occur during menopause and the cumulative effects of smoking in older women.

However, studies that find higher risks of bone fractures among smokers (compared to non-smokers) find that women are more likely to suffer from bone fractures caused by tobacco use.

Generally, smokers have a two-fold increase in bone fracture risk when compared to non-smokers.

How Smoking Can Affect Bone Health

Hormonal Changes

Smoking causes a number of hormonal changes in the body and none of these are positive.

Tobacco smoke affects the metabolism of sex hormones and its most profound effect is on the level and activity of estrogen. By stimulating increased activity of liver enzymes, tobacco smoke promotes the destruction of estrogen.

Studies show that smokers usually have elevated levels of a metabolite of estrogen, the product formed from the 2-hydroxylation of estradiol.

This estrogen-lowering effect affects bone mass much in the same way as menopause reduces bone mineral density due to lower levels of estrogen.

Another hormone affected by smoking is cortisol. Cortisol is known as the stress hormone and smokers have higher levels of this hormone than non-smokers. High levels of cortisol are also directly responsible for higher stress levels among smokers.

Cortisol promotes the breakdown of bones. Therefore, when tobacco use increases its level, the risk of osteoporotic bone fractures is also increased.

Lastly, smoking blocks the actions of the hormone, calcitonin. Calcitonin is a thyroid hormone that drives calcium from the blood into the bones. It also blocks the breakdown of bones. By reducing its level, tobacco use encourages the breakdown of bone while preventing its mineralization.

Direct Toxicity

Tobacco use can also be directly toxic to the bone. Besides nicotine, the primary addictive compound in tobacco, the other known, and suspected toxic compounds can directly kill off osteoblasts.

Osteoblasts are the cells that give rise to the bone. They produce the protein known as osteocalcin which is absolutely essential for the proper mineralization of the bones.

Smoking also damages blood vessels and nerves. This means that tobacco use can reduce blood flow and sensations in the limbs. This damage to the surrounding muscles and nerves increases the risks of injuries and bone fractures.

In addition, the damage to the blood vessels means that repair to the bones takes much longer.

Low Serum Vitamin D Levels

There is solid evidence to show that smokers have lower serum levels of vitamin D than non-smokers. Because vitamin D is important to bone health, this evidence provides further support for the harmful effect of tobacco use on the bones.

Vitamin D (along with vitamin K) is needed to move calcium from the blood to the bones where it is needed.

Lower serum vitamin D levels mean that smokers have lower bone mineral density and possible toxic levels of calcium in their blood especially if they take calcium supplements in a futile bid to improve bone health.

Calcium Inhibition

A 2003 study also found that smoking can significantly reduce the protective effect of calcium on the bones, especially in menopausal women.

The inhibition of calcium may be an offshoot of the effect of tobacco use on vitamin D levels. But this observation also indicates that smoking may affect the body’s ability to properly utilize calcium. This is not surprising considering the fact that the hormones and vitamins needed to mineralize the bone with calcium are all inhibited by tobacco use.

Body Structure Differences

Studies also confirm that smokers have different body structures when compared to non-smokers.

The most important difference is that smokers are usually thinner than a non-smoker. This is due to the depressed appetite and the unhealthy weight loss caused by tobacco smoke.

Therefore, smokers are more prone to bone fractures because of their fragile body structures. In most cases, the nerve damage and the muscle wasting that affects smokers contribute to the delicate nature of their bodies.

Considering the fact that smoking can cause a long list of nutritional deficiencies and hormonal imbalances, it is easy to see how the unideal body structures of smokers may increase the chances of sustaining injuries and bone fractures.

Lower Physical Activity and Poor Diet

Smokers are also more likely to eat poorly and to be physically less active than non-smokers.

The poor dietary choices of smokers deprive them of important nutrients required for the maintenance of healthy bones.

For example, smoking impairs the absorption of certain nutrients needed by bones such as calcium and magnesium. In addition, smoking can increase the acidity level of the body and directly strip bones of their calcium content as the body tries to maintain the right acid-base balance.

Because smokers do not usually exercise as well as non-smokers, they do not enjoy the bone-strengthening benefits of weight-bearing exercises. Therefore, the lack of exercise makes their bones more fragile.

Use of other Addictive Substances

Lastly, smokers are more likely to use other addictive and harmful substances. A good percentage of smokers are also alcoholics and alcohol is just as bad for the bones as tobacco.

Therefore, the poor lifestyle choices due to tobacco use can also be responsible for a smoker’s addiction to other sources of toxins such as alcohol and recreational drugs.

Smoking and the Risk of Bone Fracture

Listed below are the major associations between tobacco use and osteoporotic bone fractures

  • The risk of bone fracture in old age is increased by the duration of your smoking days and how many cigarettes (also pipes and cigars) you smoked
  • Bone fractures take longer to heal for smokers than non-smokers. In addition, smokers experience more complications during the healing process
  • Repeated exposure to secondhand smoke can definitely increase your risk of bone fractures later in life
  • Women who smoke experience menopause earlier than women who do not. This is because smoking lowers the level of estrogen and encourages the early onset of menopause. Therefore, women who smoke experience early and more severe bone loss
  • Quitting smoking definitely lowers the risk of bone fractures but this effect takes several years and is not comparable to that of non-smokers

Studies on Tobacco and Osteoporosis

Yes, Tobacco Use Increases the Risk of Bone Fractures

Over the last 30 years, the body of evidence to support the link between tobacco use and reduced bone mass has mounted.

Even though there are a few studies that failed to find such a link, all meta-analyses, and reviews of well-designed and unbiased studies on the subject found that tobacco use reduced bone mineral density and increased the risk of bone fractures.

One such review was published in the British Medical Journal in 1997. After analyzing 29 studies that investigated the link between tobacco and bone fractures, the reviewers concluded that there was a link between the two factors.

They determined that one in eight hip fractures was caused by tobacco smoke and that smokers lose bone mass faster than non-smokers as they age.

By the age of 80, smokers already have 6% less bone mineral density than non-smokers.

When translated to the risk of bone fractures, reviewers found that smokers had a 17% higher risk of hip fractures at age 60 than non-smokers. This risk rises to 71% at age 80 and 108% at age 90.

Another review published in the journal, Osteoporosis International, in 2005 also arrived at similar conclusions.

Here, the reviewers analyzed studies involving 59,232 participants from multiple countries.

The results of the meta-analysis showed that current smokers have significantly higher risks of all types of bone fractures than non-smokers. Osteoporotic fractures were also more common among smokers but the highest risk was associated with hip fracture.

The review also showed that male smokers were at higher risks of all fractures than female smokers. The only exception was a hip fracture.

Lastly, the reviewers found that while smokers who quit had lower risks of fractures than current smokers, their risks were still higher than for non-smokers.

Quitters are Gainers

While smoking causes a cumulative negative effect on your health, it is never too late to quit.

A number of studies have confirmed that you can still reduce your risk of bone fractures by quitting tobacco consumption. The study published in the British Medical Journal quoted above identified that quitting smoking slows down the rate of bone loss.

In addition, a 2012 study in the journal, Psychological Reports, investigating the link between smoking patterns in women and the risk of osteoporosis found that the risk was lower in former smokers.

Tobacco Consumption and Bone Mass in Men

Although smoking has been linked to lower estrogen levels, estrogen is not the only sex hormone affected by tobacco consumption.

A 1997 study published in the journal, Calcified Tissue International, investigated the effect of smoking on bone mineral density in men. For the study, the researchers recruited 57 healthy males aged 20 – 45 years. Of these participants, 31 were smokers.

By measuring hormonal levels and signs of bone metabolism, the researchers found that heavy smokers had lower bone mineral densities than non-smokers.

In addition, smokers had lower levels of the hormone, DHEAS (dehydroepiandrosterone sulfate), a testosterone metabolite.

The researchers concluded that smoking in healthy young males significantly reduces bone mass.

Smoking and Surgery

Tobacco smoke can affect wound healing and cause complications during surgery.

A 2011 study published in the Journal of Bone Mineral and Metabolism found that the changes in bone mass and bone metabolism caused by tobacco use can also affect the success of bone implantation surgeries.

A 2012 review published in the Archives of Surgery examined 140 studies involving 479,150 patients found that smoking increases the risk of necrosis, healing delay, infection, hernia, surgery complications and lack of bone healing.

They also found that quitting smoking improved the results of wound healing but the most significantly improved factor was infection.

These studies highlight the dangers of smoking with regard to wound healing. They show that tobacco use not only increases the risk of bone fractures but also slows down the healing of those fractures.

Secondhand Smoke and Osteoporosis

A 2011 study published in the journal, Osteoporosis International, investigated the possible effects of secondhand smoke on postmenopausal osteoporosis. The researchers recruited 2,057 postmenopausal women; 925 of them were non-smokers.

They determined the extent of bone loss in the study participants and correlated the results with tobacco use and exposure to secondhand smoke in the women.

The results showed that exposure to secondhand smoke increased the risk of osteoporosis even in the 925 women who had never smoked.

The Lung, the Bone, and Tobacco

Because tobacco use is known to affect the lungs earlier and more completely than any other organ of the body, a group of scientists investigated the link between the effects of tobacco on the lungs and bones to better predict osteoporosis.

In the 2010 study published in the American Journal of Respiratory and Critical Care Medicine, the researchers compared pulmonary functions in 190 subjects to their smoking habits and bone mineral densities.

The results of their study showed that osteoporosis and low bone mass was positively associated with obstructed airways and emphysema (decreased lung functions).

The researchers believed that tobacco causes bone loss and emphysema by similar mechanisms and, therefore, stated that the level of lung function can be used to predict bone mineral density in current and former smokers.

How to Lower Your Risk of Tobacco-induced Bone Fractures

Although smoking has a cumulative effect on the body, studies show that it is never too late to quit. It may take years after quitting to significantly reduce the risk of bone loss, but there are other things you can do along with quitting to slow down your bone mass.

After quitting tobacco, you should also avoid other harmful recreational drugs and alcohol.

Besides lifestyle changes, dietary changes are also important. Make sure to eat foods rich in calcium, magnesium, zinc, vitamin D and vitamin K. Vitamin D3 and vitamin K2 supplements are especially helpful and have been shown to significantly improve bone health when combined with calcium.

Lastly, and perhaps the most important advice, is to exercise regularly. Choose weight-bearing exercises.

Minerals and vitamins may help you increase your bone mass but it is exercise that strengthens your bones and makes them resistant to fractures.





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