9. Osteoporosis

Smoking may have a direct, toxic influence on bone cells through the physiological effects of nicotine and cadmium. Indirect effects may emerge due to decreased absorption of calcium and vitamin D in the alimentary canal and changes in the metabolism of adrenal gland hormones.

Smoking can also indirectly affect bone density, because smokers often have lower weight than non-smokers. On average smokers also do less physical exercise than non-smokers. Smoking women also often reach menopause 2 – 4 years earlier than non-smokers.

The influence of smoking on the reduction of oestrogen hormone possibly also contributes to the development of osteoporosis. Even though oestrogen is an important hormone from the point of view of men’s bone health, smoking does not seem to have an effect on men’s
oestradiol levels or on their bone density.

Several studies have been conducted among elderly citizens on the link between smoking and bone density. The investigations indicate that there is a clear causal connection between smoking and bone density among postmenopausal women (the period of time between the end of menstruation and old age).  In the case of older males the evidence is significant but not sufficient to prove cause-effect relationship. Bone density is lower among postmenopausal smoking females in comparison with non-smokers, and the difference is growing in a linear fashion with age, two per cent in ten years.

Research findings consistently suggest that both smoking women and men have a higher risk of hip fractures. Some of the studies indicate a dose-related association. The more one smokes the more hip fractures occur.