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Clinical Science (2007) 113, (233–241) (Printed in Great Britain)

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Review article

The effects of smoking on bone health

Peter K. K. WONG*, Jemma J. CHRISTIE† and John D. WARK†‡

*Department of Rheumatology, Royal Melbourne Hospital, Parkville, Victoria 3050, Australia, †Department of Medicine, University of Melbourne, Royal Melbourne Hospital, Parkville, Victoria 3050, Australia, and ‡Bone and Mineral Service, Royal Melbourne Hospital, Parkville, Victoria 3050, Australia

Key words: bone, bone mineral density, fracture, osteoporosis, public health, smoking.

Abbreviations: BMD, bone mineral density; BMI, body mass index; CI, confidence interval; DHEA, dehydroepiandrosterone; HRT, hormone replacement therapy; OR, odds ratio; RR, risk ratio; SHBG, sex hormone-binding globulin.

Correspondence: Professor John D. Wark (email jdwark@unimelb.edu.au).

Osteoporotic fractures are a major public health problem in most developed countries and an increasing concern in much of the developing world. This healthcare burden will increase significantly worldwide over the next 20 years due to aging of the population. Smoking is a key lifestyle risk factor for bone loss and fractures that appears to be independent of other risk factors for fracture such as age, weight, sex and menopausal status. This review discusses the effects of smoking on bone health in pre-menopausal and post-menopausal women and men. Data from twin studies and the three main published meta-analyses are presented. Possible mechanisms by which smoking affects bone mass are reviewed. Despite smoking being a major lifestyle risk factor for osteoporosis, the mechanisms underlying smoking-associated bone loss and fracture risk remain poorly understood. The effect appears dose-dependent, and may be, at least partially, reversible. However, more work is required to confirm and characterize the reversibility of smoking-associated bone defects. Finally, strategies for quitting smoking are discussed. Encouragement of lifestyle alterations, including smoking cessation, should be a major component of any bone therapeutic programme.

Received 4 July 2006/28 February 2007; accepted 29 March 2007

Published on the Internet 1 August 2007, doi:10.1042/CS20060173

© The Authors Journal compilation © 2007 Biochemical Society