3.13 Bone density and risk of fractures

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3.0 Background

3.1 Tobacco—a leading preventable cause of death and disease

3.2 Cardiovascular diseases

3.3 Lung cancer

3.4 Respiratory diseases

3.5 Other cancers caused by or associated with smoking

3.6 Reproductive health and smoking

3.7 Pregnancy and smoking

3.8 Infant health and smoking

3.9 Increased susceptibility to infection in smokers

3.10 Eye diseases

3.11 Dental diseases

3.12 Gastrointestinal diseases

3.13 Bone density and risk of fractures

3.14 Effects of smoking on the skin

3.15 Smoking and complications in medical treatment

3.16 Smoking and diabetes

3.17 Poorer levels of general health

3.18 Smoking, motor vehicle crashes and other injuries

3.19 Burns and fires caused by tobacco use

3.20 Tobacco poisoning

3.21 Health effects for younger smokers

3.22 Genetic influences on tobacco-caused disease

3.23 Smoking, dementia and cognitive decline

3.24 Lung disease, smoking and occupational exposures

3.25 Air pollution, cigarette smoking and ill health

3.26 Health effects of smoking brands that claim to deliver lower levels of tar, nicotine and carbon monoxide

3.27 Health effects of smoking tobacco in other forms

3.28 Health 'benefits' of smoking?

3.29 Morbidity (ill health) attributable to tobacco-caused disease

3.30 Deaths attributable to tobacco by disease category

3.31 Morbidity and mortality due to tobacco-caused disease and socioeconomic disadvantage

3.32 Health effects of smoking other substances

3.33 Health effects of chewing tobacco, and of other smokeless tobacco products

3.34 Public perceptions of tobacco as a drug, and knowledge and beliefs about the health consequences of smoking

3.35 Health benefits of cessation

3.36 The global tobacco pandemic

Acknowledgments

References

Hip fractures are a major cause of injury, ongoing disability and loss of quality of life for elderly Australians, and they can also shorten life expectancy.28, 67 As the population ages, the burden of hip fracture can be expected to rise.67

Major reviews of the evidence to date show that smoking reduces bone density, and causes hip fractures in women who have passed menopause.5, 67 A number of mechanisms may contribute to this. Nicotine and cadmium found in cigarette smoke may have a direct effect on bone cells, and smokers' bone density could also be impaired through lower absorption of calcium and vitamin D, and altered metabolism of some other hormones. Smoking also affects oestrogen levels, including the effectiveness of hormonal replacement therapy. Smokers also tend to have a lower body weight, and be less physically active than non-smokers, both factors which affect bone density, and also to reach menopause earlier, thereby extending the postmenopausal period of accelerated bone mineral loss.5 There is also some evidence that older smokers are more likely to fall than non-smokers, due to increased likelihood of neuromuscular and physical impairment.68

While smoking does not appear to have any significant effect on bone density in women prior to menopause, following menopause reduction in bone density is incrementally greater than in smokers than non-smokers, leading to an increased risk of fracture. Female smokers aged 60 have a 17% greater likelihood of experiencing a hip fracture than non-smoking females and the risk continues to increase with age, rising to 71% at the age of 80 years and more than double the risk for non-smokers by age 90.5 The risk of bone loss appears to increase with the amount smoked. Some of this effect may be reversible following smoking cessation, but more research is needed.67

Data for older males and hip fracture are more limited, but suggest similar trends.5, 67 Positive associations have been found between smoking and an increased risk of fracture at other sites in older population groups, but at this stage are not conclusive.5