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A meta-analysis of cigarette smoking, bone mineral density and risk of hip fracture: recognition of a major effect.

Abstract

OBJECTIVE

To determine the magnitude and importance of the relation between smoking, bone mineral density, and risk of hip fracture according to age.

DESIGN

Meta-analysis of 29 published cross sectional studies reporting the difference in bone density in 2156 smokers and 9705 non-smokers according to age, and of 19 cohort and case-control studies recording 3889 hip fractures reporting risk in smokers relative to non-smokers.

RESULTS

In premenopausal women bone density was similar in smokers and non-smokers. Postmenopausal bone loss was greater in current smokers than non-smokers, bone density diminishing by about an additional 2% for every 10 year increase in age, with a difference of 6% at age 80. In current smokers relative to non-smokers the risk of hip fracture was similar at age 50 but greater thereafter by an estimated 17% at age 60, 41% at 70, 71% at 80, and 108% at 90. These estimates of relative risk by age, derived directly from a regression analysis of the studies of smoking and hip fracture, were close to estimates using the difference in bone density between smokers and non-smokers and the association between bone density and risk of hip fracture. The estimated cumulative risk of hip fracture in women in England was 19% in smokers and 12% in non-smokers to age 85; 37% and 22% to age 90. Among all women, one hip fracture in eight is attributable to smoking. Limited data in men suggest a similar proportionate effect of smoking as in women. The association was not explained by smokers being thinner, younger at menopause, and exercising less nor by actions of smoking on oestrogen, but smoking may have a direct action on bone.

CONCLUSIONS

Hip fracture in old age is a major adverse effect of smoking after the menopause. The cumulative excess bone loss over decades is substantial, increasing the lifetime risk of hip fracture by about half.

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  • Authors+Show Affiliations

    ,

    Department of Environmental and Preventive Medicine, Wolfson Institute of Preventive Medicine, St Bartholomew's, London.

    Source

    BMJ (Clinical research ed.) 315:7112 1997 Oct 04 pg 841-6

    MeSH

    Adult
    Aged
    Aged, 80 and over
    Bone Density
    Case-Control Studies
    Cohort Studies
    Female
    Hip Fractures
    Humans
    Male
    Middle Aged
    Postmenopause
    Premenopause
    Risk Factors
    Smoking

    Pub Type(s)

    Journal Article
    Meta-Analysis

    Language

    eng

    PubMed ID

    9353503

    Citation

    Law, M R., and A K. Hackshaw. "A Meta-analysis of Cigarette Smoking, Bone Mineral Density and Risk of Hip Fracture: Recognition of a Major Effect." BMJ (Clinical Research Ed.), vol. 315, no. 7112, 1997, pp. 841-6.
    Law MR, Hackshaw AK. A meta-analysis of cigarette smoking, bone mineral density and risk of hip fracture: recognition of a major effect. BMJ. 1997;315(7112):841-6.
    Law, M. R., & Hackshaw, A. K. (1997). A meta-analysis of cigarette smoking, bone mineral density and risk of hip fracture: recognition of a major effect. BMJ (Clinical Research Ed.), 315(7112), pp. 841-6.
    Law MR, Hackshaw AK. A Meta-analysis of Cigarette Smoking, Bone Mineral Density and Risk of Hip Fracture: Recognition of a Major Effect. BMJ. 1997 Oct 4;315(7112):841-6. PubMed PMID: 9353503.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - A meta-analysis of cigarette smoking, bone mineral density and risk of hip fracture: recognition of a major effect. AU - Law,M R, AU - Hackshaw,A K, PY - 1997/11/14/pubmed PY - 1997/11/14/medline PY - 1997/11/14/entrez SP - 841 EP - 6 JF - BMJ (Clinical research ed.) JO - BMJ VL - 315 IS - 7112 N2 - OBJECTIVE: To determine the magnitude and importance of the relation between smoking, bone mineral density, and risk of hip fracture according to age. DESIGN: Meta-analysis of 29 published cross sectional studies reporting the difference in bone density in 2156 smokers and 9705 non-smokers according to age, and of 19 cohort and case-control studies recording 3889 hip fractures reporting risk in smokers relative to non-smokers. RESULTS: In premenopausal women bone density was similar in smokers and non-smokers. Postmenopausal bone loss was greater in current smokers than non-smokers, bone density diminishing by about an additional 2% for every 10 year increase in age, with a difference of 6% at age 80. In current smokers relative to non-smokers the risk of hip fracture was similar at age 50 but greater thereafter by an estimated 17% at age 60, 41% at 70, 71% at 80, and 108% at 90. These estimates of relative risk by age, derived directly from a regression analysis of the studies of smoking and hip fracture, were close to estimates using the difference in bone density between smokers and non-smokers and the association between bone density and risk of hip fracture. The estimated cumulative risk of hip fracture in women in England was 19% in smokers and 12% in non-smokers to age 85; 37% and 22% to age 90. Among all women, one hip fracture in eight is attributable to smoking. Limited data in men suggest a similar proportionate effect of smoking as in women. The association was not explained by smokers being thinner, younger at menopause, and exercising less nor by actions of smoking on oestrogen, but smoking may have a direct action on bone. CONCLUSIONS: Hip fracture in old age is a major adverse effect of smoking after the menopause. The cumulative excess bone loss over decades is substantial, increasing the lifetime risk of hip fracture by about half. SN - 0959-8138 UR - https://www.unboundmedicine.com/medline/citation/9353503/A_meta_analysis_of_cigarette_smoking_bone_mineral_density_and_risk_of_hip_fracture:_recognition_of_a_major_effect_ L2 - http://www.bmj.com/cgi/pmidlookup?view=long&pmid=9353503 DB - PRIME DP - Unbound Medicine ER -