More evidence: Smoking raises risk of bone fractures—another reason to quit?

By Sarah Handzel, BSN, RN | Fact-checked by MDLinx staff

Published July 14, 2022

Key Takeaways

A new meta-analysis confirms existing evidence that smoking is a major risk factor for bone fractures and osteoporosis, particularly among men.
Further, about 21% of physicians continue to smoke despite having a greater understanding of the dangers of such behavior, according to a 2021 study.
The same smoking cessation methods that apply to patients are also practical for physicians; both counseling and the use of certain medications can be helpful.

Thanks to national smoking cessation campaigns in the United States, 61.7% of adult smokers who have ever smoked cigarettes have quit. That equals 55 million Americans.^[] Yet smoking rates among healthcare workers, particularly male physicians, remains relatively high.

About 21% of physicians continue to smoke despite having a greater understanding of the dangers of such behavior, according to a 2021 study.^[] Now, a new meta-analysis confirms evidence that smoking increases the risk of bone fractures, especially in men—raising further concern for both patients and clinicians who still engage in this habit.

Smoking represents a major public health issue, and physicians are poised to help others quit. But factors such as workload, stress, and other working conditions may inhibit these same physicians from quitting themselves.

Smoking and bone fractures in men

Numerous studies link smoking to a wide variety of health problems, including cancer, heart disease, stroke, diabetes, certain eye diseases, and even immune system problems. In a meta-analysis published in June in Scientific Reports, researchers at the University of Nevada, Las Vegas (UNLV), found that smoking increases the risk of bone fractures by as much as 37%. Additionally, men appear to be at higher risk compared with women who smoke.^[]

To arrive at their conclusion, the research team reviewed broken bone cases from 27 research publications spanning the last 30 years. Unlike past research, which focused primarily on hip fractures, this meta-analysis included information about wrist, shoulder, forearm, spinal, femur, and lower leg fractures.

The study also supported previous research, which found that men who smoke have a 32% higher risk of spinal fractures and a 40% higher risk of hip fractures. Of these men, up to 37% die within one year of their bone fracture.

"Smoking is a major risk factor for osteoporosis and risk of fracture," said study lead author Qing Wu, a researcher with UNLV's School of Public Health and the university's Nevada Institute of Personalized Medicine, in a release about the study.^[] "Men tend to smoke more than women, increasing their risk for osteoporosis, which has traditionally been thought of as a women's disease."

Researchers don't entirely understand smoking's association with fracture risk, the authors noted. However, it is believed that the chemicals in cigarettes affect bone cells and interfere with the body's ability to absorb vitamin D and calcium, both essential nutrients for strong bones.

"Our results have crucial implications in public health, with the most apparent being that quitting smoking can reduce an individual's risk of bone fracture, both now and later in life."

— Authors, Scientific Reports

The challenge of quitting

Many physicians, particularly those in family practice and other medical specialties, already have experience with the quitting process; after all, providers are on the front line of efforts to help members of the public stop smoking.

However, physicians and other healthcare professionals may still have difficulty quitting even though they have a greater understanding of the negative health consequences.

The same smoking cessation methods that apply to the general public are also practical for physicians; both counseling and the use of certain medications like varenicline or bupropion can be extremely beneficial.^[]

However, doctors may have greater access to cessation medications, along with better insurance coverage which may help pay for additional quitting aids.

As research continues to confirm the harmful effects of smoking, physicians should examine their own relationship with cigarettes and other tobacco products. Taking steps to quit helps negate many preventable health issues, including the risk of bone fractures.

What this means for you

Physicians are well aware of the significant health problems associated with smoking. A meta-analysis out of University of Nevada, Las Vegas, provides reinforcement that smoking is a major risk factor for fractures and osteoporosis. Perhaps it's one more reason to quit? If you're a clinician who smokes, it is important to evaluate your readiness to quit and then take steps to do so. The same goes for your patients. The CDC and other online resources offer help with the process of quitting.