What to know about smoking and osteoporosis

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Scientists have found a link between smoking and decreased bone density or bone loss. Research indicates that smoking may increase a person’s risk of developing osteoporosis.

However, the link may be due to other osteoporosis risk factors that also occur in people who smoke. These risk factors may include:

• having low body weight
• heavy drinking of alcohol
• being less physically active
• eating a diet low in certain nutrients and vitamins, such as calcium and vitamin D

Several recent studies have investigated links between smoking and osteoporosis.

In a 2018 study, scientists reviewed the effects of first and secondhand smoke on bone mass. They found smoking causes an imbalance in bone turnover, which is a lifelong process where a person’s body reabsorbs and reforms their bone structure.

The imbalance in bone turnover caused by smoking leads to a lower bone mass. This makes people more likely to have osteoporosis and bone fractures.

The scientists found that both first and secondhand smoke negatively affected a person’s bone mass. However, they also concluded that if a person stops smoking, they could reverse this effect and improve their bone mass again.

Some researchers have also studied the effect of cadmium in cigarette smoke on a person’s risk of developing osteoporosis. Cadmium is a type of metal and a known risk factor for osteoporosis.

In a 2020 study, scientists studied 886 men aged over 70. They collected physical data and studied the effect of smoking on these men from 2002–2018. Based on an analysis of this data, they concluded that the cadmium in cigarette smoke may play an important role in the development of osteoporosis.

In a 2022 review, researchers summarized the latest research into the way smoking causes osteoporosis. They found that smoking may, directly and indirectly, induce osteoporosis in several different ways.

The researchers also noted that there are currently no effective ways to stop smoking-induced osteoporosis because scientists do not fully understand the specific mechanisms through which smoking affects bone metabolism.

Scientists believe smoking can also weaken a person’s bones and joints in other ways. In the 2018 study mentioned above, researchers found that smoking may cause other bone-related conditions, such as:

• rheumatoid arthritis, a condition that damages a person’s joints and may cause their bones to erode
• periodontitis, a condition that damages a person’s gums and the bone that supports the teeth

Smoking may also:

• Break down hormones responsible for strong bones more quickly: Hormones, such as estrogen, are important for building and maintaining strong bones. Smoking causes estrogen to break down more quickly, leading to weaker bones.
• Increase a person’s hormone levels: Long-term smokers may have higher levels of certain hormones, such as cortisol, androstenedione, and dehydroepiandrosterone. High levels of these hormones may contribute to a decrease in bone mass and alter bone metabolism.
• Have a detrimental effect on fracture and wound healing: The harmful effects of nicotine on the production of bone-forming cells may lead to fractures taking longer to heal in smokers.

People can manage their osteoporosis symptoms. Stopping smoking at any stage of life may help limit smoking-related bone loss, which helps manage osteoporosis.

Other tips for managing osteoporosis can help people slow bone loss and reduce their risk of fractures. These tips include:

• avoiding activities that may cause fractures, such as golfing or situp exercises
• preventing falls by:
  • exercising to improve strength and balance
  • standing up slowly or using a mobility aid, such as a cane or walker, for steadiness
  • installing night lights and grab bars in the home bathroom
  • taking extra care using stairs during rainy or wet weather
• eating a well-balanced diet rich in calcium and vitamin D
• limiting alcohol consumption

Healthcare professionals can help people quit smoking. Doctors may prescribe treatments to help people quit, such as:

• counseling, to help people plan and cope with quitting
• prescription or over-the-counter medication that helps people manage nicotine withdrawal symptoms and cravings
• a combination of both medication and counseling

Quitting smoking may help reduce a person’s risk of many conditions, including osteoporosis.

The CDC has a free quitline to help people stop smoking. The helpline provides confidential free coaching with a trained quit coach. A person can access the helpline by calling 1-800-784-8669 in the U.S.

Doctors can also find out if someone may be at risk of osteoporosis and help them reduce their risk of developing the condition. If a person does have osteoporosis, a healthcare professional can help them manage the condition.

Scientists have linked smoking to osteoporosis in several studies. While people who smoke tend to have an increased risk of developing osteoporosis, this may be due to them having other risk factors for the condition, as well.

However, stopping smoking does have many health benefits, including decreasing a person’s risk of developing osteoporosis. People can also manage osteoporosis by eating a balanced diet, avoiding activities that may cause fractures, limiting alcohol consumption, and preventing falls.

A person should speak with a doctor for further information about quitting smoking and managing osteoporosis on an individual basis.