Abstract
To assess the effect of smoking on bone mineral density (BMD) at different life stages, to examine whether the effect of smoking differs between men and women, and to discover whether its effect in women differs according to history of estrogen use, a cohort study was carried out with single cross-section measurement of BMD by single and dual photon absorptiometry. The setting was the Framingham Study, a population-based cohort study with over 40 years prospectively collected data on smoking. Subjects (n=1164) consisted of cohort members participating in the 20th biennial Framingham examination (1988–1989). The measurements included in the study were BMD measured at the hip, spine and radius, smoking history ascertained at all Framingham Study examinations since 1948, and other factors affecting BMD (age, weight, estrogen use, caffeine use, alcohol use and physical activity). Neither current smoking, recent (last 10 years) smoking, nor early adulthood smoking resulted in significantly lower BMD at any skeletal site among women who had not taken estrogen. Among women who had taken estrogen, BMD at most sites was lower among current or recent smokers, although the small numbers of smokers made it difficult to find significant differences at all skeletal sites. Among men, a consistently lower BMD at all skeletal sites was observed for smokers regardless of when in their life they smoked (4–15.3% lower), although the effect of smoking during early adulthood was of a lesser magnitude (4–8% lower). Former male smokers who had quit <10 years ago had lower BMD than men who had quit ≥10 years ago. In conclusion, in women who had used estrogen, BMD was lower in current or recent smokers than it was in non-smokers. In men, smoking at any stage of life had adverse effects on the skeleton that was independent of weight, alcohol or caffeine use, implying other mechanisms for smoking's effect on bone.
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References
Sowers M, Wallace RB, Lemke JH. Correlates of mid-radius bone density among postmenopausal women: a community study. Am J Clin Nutr 1995;41:1045–53.
Jensen GF. Osteoporosis of the slender smoker revisited by epidemiologic approach. Eur J Clin Invest 1986;16:239–42.
Daniel M, Martin AD, Drinkwater DT. Cigarette smoking, steroid hormones, and bone mineral density in young women. Calcif Tissue Int 1992;50:300–5.
Jones G, Nguyen T, Sambrook P, Kelly PJ, Eisman JA. Progressive loss of bone in the femoral neck in elderly people: longitudinal findings from the Dubbo Osteoporosis Epidemiology Study. BMJ 1994;309:691–5.
Mazess RB, Barden HS. Bone density in premenopausal women: effects of age, dietary intake, physical activity, smoking, and birth control pills. Am J Clin Nutr 1991;53:132–42.
McCulloch RG, Whiting SJ, Bailey DA, Houston CS. The effect of cigarette smoking on trabecular bone density in premenopausal women aged 20–35 years. Can J Public Health 1991;82:434–5.
Krall EA, Dawson-Hughes B. Smoking and bone loss among postmenopausal women. J Bone Miner Res 1991;6:331–8.
Kiel DP, Baron JA, Anderson JJ, Hannan MT, Felson DT. Smoking eliminates the protective effect of oral estrogens on the risk for hip fracture among women. Ann Intern Med 1992;116:716–21.
Michnovicz JJ, Herschcopf RJ, Naganuma H, Bradlow HL, Fishman J. Increased 2-hydroxylation of estradiol as a possible mechanism for the anti-estrogenic effect of cigarette smoking. N Engl J Med 1986;315:1305–9.
Jensen J, Christiansen C. Effects of smoking on serum lipoproteins and bone mineral content during postmenopausal hormone replacement therapy. Am J Obstet Gynecol 1988;159:820–5.
Hannan MT, Felson DT, Anderson JJ. Bone mineral density in elderly men and women: results from the Framingham osteoporosis study. J Bone Miner Res 1992;7:547–53.
Felson DT, Kiel DP, Anderson JJ, Kannel WB. Alcohol consumption and hip fractures: the Framingham Study. Am J Epidemiol 1988;128:1102–10.
Bunker ML, McWilliams M. Caffeine content of common beverages. J Am Diet Assoc 1979;74:28–32.
Lecos C. The latest caffeine Scoreboard. Consum Res 1984;67:35–6.
Felson DT, Zhang Y, Hannan MT, Kiel DP, Wilson PWF, Anderson JJ. The effect of postmenopausal estrogen therapy on bone density in elderly women. N Engl J Med 1993;329:1141–6.
Lindsay R. The influence of cigarette smoking on bone mass and bone loss. In: De Luca HF, Frost HM, Jee WSS, Johnston CC, Parfitt AM, editors. Osteoporosis: recent advances in pathogenesis and treatment. Baltimore, MD: University Park Press, 1981.
Hollenbach KA, Barrett-Connor E, Edelstein SL, Holbrook T. Cigarette smoking and bone mineral density in older men and women. Am J Public Health 1993;83:1265–70.
Bauer DC, Browner WS, Cauley JA, Orwoll ES, Scott JC, Black DM, Tao JL, Cummings SR, et al. Factors associated with appendicular bone mass in older women. Ann Intern Med 1993;118:657–65.
Cheng S, Huominen H, Heikkinen E. Bone mineral density in relation to anthropometric properties, physical activity and smoking in 75-year-old men and women. Aging Clin Exp Res 1993;5:55–62.
Nguyen TV, Kelly PJ, Sambrook PN. Gilbert C, Pocock NA, Disman JA. Lifestyle factors and bone density in the elderly: implications for osteoporosis prevention. J Bone Miner Res 1994;9:1339–46.
Cauley JA, Seeley DG, Ensrud K, Ettinger B, Black D, Cummings SR. Estrogen replacement therapy and fractures in older women. Ann Intern Med 1995;122:9–16.
Cummings SR, Black DM, Nevitt MC, et al. Bone density at various sites for prediction of hip fractures. Lancet 1993;341:72–5.
Seeman E, Melton LJ, O'Fallon WM, Riggs BL. Risk factors for spinal osteoporosis in men. Am J Med 1983;75:977–83.
Hollo I, Gergely I, Boross M. Influence of heavy smoking upon the bone mineral content of the radius of the aged and effect of tobacco smoke on the sensitivity to calcitonin of rats. Aktuelle Gerontol 1979;9:365–8.
Rundgren A, Mellstrom D. The effect of tobacco smoking on the bone mineral content of the ageing skeleton. Mech Ageing Dev 1984;28:273–7.
Suominen H, Heikkinen E, Vainio P, Lahtinen T, Mineral density of calcaneus in men at different ages: a population study with special reference to life-style factors. Age Ageing 1984;13:273–81.
Johansson C, Mellstrom D, Lerner U, et al. Coffee drinking: a minor risk factor for bone loss and fractures. Age Ageing 1992;21:20–6.
Shaw CK. An epidemiologic study of osteoporosis in Taiwan. Ann Epidemiol 1993;3:264–71.
Kato I, Nomura A, Stemmermann GN, Chyou PH. Determinants of sex hormone levels in men as useful indices in hormone-related disorders. J Clin Epidemiol 1992;45:1417–21.
Simon D, Preziosi P, Barrett-Connor E, Roger M, Saint-Paul M, Nahoul K, Papoz L. The influence of aging on plasma sex hormones in men: the telecom study. Am J Epidemiol 1992;135:783–91.
Longcope C, Goldfield SRW, Brambila DJ, McKinlay J. Androgens, estrogens, and sex hormone-binding globulin in middle-aged men. J Clin Endocrinol Meta 1990;71:1442–6.
Dai WS, Gutai JP, Kuller LH, Cauley JA, et al. Cigarette smoking and serum sex hormones in men. Am J Epidemiol 1988;128:796–805.
Aloia JF, Vaswani AN, Yeh JK, Ross P, Ellis K, Cohn SH. Determinants of bone mass in postmenopausal women. Arch Intern Med 1983;143:1700–4.
Mussalo-Rauhamaa H, Salmela SS, Leppanen A, Pyysalo H. Cigarettes as a source of some trace and heavy metals and pesticides in man. Arch Environ Health 1986;41:49–55.
Bhattacharyya MH, Whelton BD, Stern PH, Peterson DP, Cadmium accelrates bone loss in ovariectomized mice and fetal rat limb bones in culture. Proc Natl Acad Sci USA 1988;85:8761–5.
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Kiel, D.P., Zhang, Y., Hannan, M.T. et al. The effect of smoking at different life stages on bone mineral density in elderly men and women. Osteoporosis Int 6, 240–248 (1996). https://doi.org/10.1007/BF01622741
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DOI: https://doi.org/10.1007/BF01622741