Table 6.15Cross-sectional studies on the association between smoking status and bone density in women*

StudyMean (range) age (years)Smoking statusSite of bone density measurementFindings
Premenopausal
Fehily et al. 199222 (20–23)104 current smokers
78 never/former smokers
RadiusNo differences in BMD between smokers (0.71 g/cm2 [SD = 0.07]) and nonsmokers (0.71 [0.06])
Välimäki et al. 199424 (20–29)9 current smokers
47 never smokers
FemurMean BMD in g/cm2 (SD) at hip = 0.914 (0.102) for smokers compared with 0.956 (0.100) for nonsmokers; adjusted for age, weight, and exercise
McCulloch et al. 199028 (20–35)25 current smokers
76 never/former smokers
CalcaneusMean BMD in g/cm2 = 177.8 (54.1) for smokers compared with 190.6 (52.9) for nonsmokers
Ortego-Centeno et al. 199428 (SD = 7)47 current smokers
54 never/former smokers
FemurFemoral neck BMD in g/cm2 (SD) for smokers = 0.796 (0.118), nonsmokers = 0.838 (0.123), p <0.05; lumbar spine for smokers = 1.025 (0.108), nonsmokers = 1.039 (0.106), p = not significant
Daniel et al. 199229 (20–35)25 current smokers
27 never/former smokers
FemurMean BMD in g/cm2 (SD) = 1.16 (0.014) for smokers compared with 1.151 (0.014) for nonsmokers; adjusted for weight (p = 0.140)
Mazess and Barden 199130 (20–39)23 current smokers
195 never/former smokers
Femur, lumbar spine, and radiusSpine BMD was significantly lower for smokers compared with nonsmokers (t = 2.26, p <0.05)
Sowers et al. 199236 (22–54)31 current smokers
77 never/former smokers
RadiusRadial BMD loss in g/cm2 (SD) = 0.71 (0.01) for smokers compared with 0.74 (0.008) for nonsmokers (p = 0.300)
Law et al. 199737 (35–39)28 current smokers
72 never smokers
RadiusDifference between current and nonsmokers = 0.43 (95% CI§, −0.73–1.59)
42 (40–44)63 current smokers
115 never smokers
Radius
47 (45–49)50 current smokers
107 never smokers
Radius
52 (50–54)14 current smokers
79 never smokers
Radius
Hopper and Seeman 199442 (27–49)9 current smokers
9 never smokers
FemurStudy of twin pairs found that BMD was lower for the twin who smoked more heavily
Johnell and Nilsson 198449 (49)186 current smokers
185 never/former smokers
RadiusDistal BMCΔ in mg/cm2 = 320 (SD = 73) for smokers compared with 318 (77) for nonsmokers; proximal = 538 (68) for smokers compared with 533 (62) for nonsmokers; results were not significant
Postmenopausal
Law et al. 199745 (39–49)24 current smokers
56 never smokers
RadiusDifference in BMD between current smokers and nonsmokers = −0.17 g/cm2 (95% CI, −1.88–1.54)
52 (50–54)31 current smokers
83 never smokers
Radius
57 (55–59)32 current smokers
135 never smokers
Radius
62 (60–64)27 current smokers
65 never smokers
Radius
Jensen and Christiansen 198850 (44–53)56 current smokers
54 never/former smokers
RadiusNo odds ratio was given for smoking
Jensen et al. 198551 (44–56)67 current smokers
69 never/former smokers
RadiusBMCΔ (g/cm) = 38.2 (95% CI, 20.9–48.7) in smokers compared with 38.0 (95% CI, 24.9–58.9) in nonsmokers
Slemenda et al. 198951 (45–57)21 current smokers
63 never/former smokers
Radius and lumbar spineFor current smokers of >20 pack-years, midradius had a −0.0034 g/cm2 (SD = 0.169) change in bone mass/year, distal radius = −0.0071 (0.0180), and lumbar spine = −0.0261 (0.0476); for current smokers of <20 pack-years, midradius = −0.0023 (0.0135), distal radius = −0.0113 (0.0366), and lumbar spine = 0.0136 (0.0800); and for nonsmokers, midradius = −0.0072 (0.0111), distal radius = −0.0071 (0.0172), and lumbar spine = −0.0120 (0.0409)
McDermott and Witte 198853 (SD = 10)24 current smokers
24 never smokers
RadiusBMC (g/cm) midradius = 0.89 (0.03) for smokers compared with 0.87 (0.02) for nonsmokers (p = 0.66); distal radius = 0.87 (0.03) for smokers compared with 0.87 (0.03) for nonsmokers (p = 0.98)
Premenopausal
Guthrie et al. 199654 (48–57)7 current smokers
39 never/former smokers
FemurSmoking was associated with a lower BMD
Cheng et al. 199154 (50–60)25 current smokers
82 never/former smokers
CalcaneusBMD (g/cm2) was lower among smokers (0.170 [SD = 0.025]) than nonsmokers (0.180 [0.029] p >0.05)
Krall and Dawson-Hughes 199159 (40–70)35 current smokers
267 never/former smokers
FemurMean BMD (g/cm2) of current smokers = 0.611 (SD = 0.012) for radius, 0.787 (0.015) for femoral neck, and 1.084 (0.021) for spine; for current nonsmokers radius = 0.614 (0.005), femoral neck = 0.793 (0.007), and spine = 1.080 (0.009)
Hopper and Seeman 199462 (50–73)7 current smokers
7 nonsmokers
FemurStudy of twins discordant for tobacco use, by menopause status, BMD was lower for the twin who smoked more heavily
Sowers et al. 198562 (55–80)119 current smokers
278 never smokers
RadiusMean BMD = 0.633 (SD = 0.014) for smokers of 1–9,000 pack-days, and 0.637 (SD = 0.014) for >9,000 pack-days compared with 0.625 (SD = 0.005) for nonsmokers (findings were not significant); adjusted for age to 66 years and median muscle mass
Hansen et al. 199163 (59–67)61 current smokers
60 never/former smokers
FemurSmokers had a lower BMD (g/cm2) 0.69 (SD = 0.11) than nonsmokers 0.65 (0.09)
Egger et al. 199666 (63–68)23 current smokers
99 never smokers
Femur and lumbar spineMean (g/cm2) change/decade of smoking = −0.015 (95% CI, −0.028 to −0.003) for lumbar spine and −0.004 (−0.012 to −0.003) for femoral neck; adjusted for age, weight, height, alcohol use, calcium intake, and physical activity
Holló et al. 197968 (61–75)41 current smokers
125 never smokers
RadiusSmokers had a lower BMCΔ (0.68 g/cm [SD = 0.10]) than nonsmokers (0.72 [0.10]), p <0.05
Nguyen et al. 199470 (>60)102 current smokers
765 never smokers
Femur and lumbar spineLumbar spine BMD = 0.96 g/cm2 (SD = 0.22) for current smokers, 1.03 (0.17) for former smokers, and 1.02 (0.19) for never smokers; femoral neck BMD = 0.73 (0.10) for current smokers, 0.78 (0.12) for former smokers, and 0.79 (0.13) for never smokers (p <0.05 for current smokers vs. nonsmokers for both comparisons)
Jensen 198670 (70)77 current smokers
103 never smokers
Radius40.3% of smokers and 44.7% of nonsmokers had some type of fracture (hip, proximal, distal radius, vertebral, or long bones)
Johansson et al. 199270 (70)38 current smokers
200 never smokers
Calcaneusr = 0.15, p <0.01 comparing current, former, and nonsmokers
Rundgren and Mellström 198470 (70)43 current smokers
243 never smokers
CalcaneusAmong 70-year-old current smokers, BMD (μm) = 784 (SD = 252) compared with former smokers (884 [280], p <0.05) and nonsmokers (928 [273], p <0.001); among current smokers aged 75 years, 759 (260) compared with former smokers (950 [282], p <0.05) and nonsmokers (878 [268], p <0.01); and among current smokers aged 79 years, 554 (258) compared with former smokers (748 [372], p <0.05) and nonsmokers (807 [329], p <0.001)
75 (75)49 current smokers
364 never smokers
Calcaneus
79 (79)19 current smokers
218 never smokers
Calcaneus
Bauer et al. 199371 (65–84)485 current smokers
4,367 never smokers
RadiusPercentage change in bone mass (g/cm2) = −0.04 (95% CI, −0.9–0.8) for lifetime cigarettes smoked (per 20 pack-years)
Kiel et al. 199674 (68–98)77 current smokers
340 never smokers
FemurAmong estrogen users, current smokers had a lower BMD of the trochanter (0.589 g/cm2) than nonsmokers (0.640, p = 0.05)
Cheng et al. 199375 (75)10 current smokers
161 never smokers
CalcaneusCurrent smokers had a lower mean BMD (0.114 g/cm3 [SD = 0.023]) than nonsmokers (0.129 [0.036] p >0.05)
Hollenbach et al. 199376 (60–89)42 current smokers
320 never smokers
FemurCurrent smokers had a lower mean femoral neck BMD (0.608 [SD = 1.008]) than nonsmokers (0.632 [0.005] p <0.01)
*

Note: See Figure 6.2 for results. The order of the studies in this table reflects the order of the regression lines in Figure 6.2.

BMD = Bone mineral density.

SD = Standard deviation.

§

CI = Confidence interval.

Δ

BMC = Bone mineral content.

Pack-years = The number of years of smoking multiplied by the number of packs of cigarettes smoked per day.

Note: See Figure 6.2 for results. The order of the studies in this table reflects the order of the regression lines in Figure 6.2.

BMD = Bone mineral density.

SD = Standard deviation.

CI = Confidence interval.

BMC = Bone mineral content.

Pack-years = The number of years of smoking multiplied by the number of packs of cigarettes smoked per day.

From: 6, Other Effects

Cover of The Health Consequences of Smoking
The Health Consequences of Smoking: A Report of the Surgeon General.
Office of the Surgeon General (US); Office on Smoking and Health (US).

NCBI Bookshelf. A service of the National Library of Medicine, National Institutes of Health.