Does Smoking Cause Osteoporosis?

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Smoking has detrimental effects on your body. It adversely affects your internal organs and their functioning. Among other disorders that are linked to smoking, scientific research indicates that smoking is also a risk factor for bone weakening, osteoporosis, and fractures.

How Does Smoking Cause Osteoporosis

The Center for Disease Control and Prevention states that around 55 million people in the United States suffer from osteoporosis. Moreover, it is prevalent among 200 million people worldwide.

Insights into Osteoporosis

Osteoporosis is a condition that affects bones, making them less dense and prone to fractures.

It causes a reduction in bone mass (osteopenia) leading to bone thinning and bone fracture in complicated cases. To sum up, osteoporosis is characterized by weak bones, bone thinning, lesser bone density, bone loss, and fracture.

Apart from smoking, other risk factors for osteoporosis include:

  • Family history of osteoporosis and rheumatoid arthritis.
  • Small skeletal framework and thin bones
  • Menopause or early menopause.
  • Amenorrhea or absence of menstruation
  • Calcium deficiency
  • Lack of physical activity 
  • Excessive alcohol consumption
  • Prolonged use of drugs that treat asthma, thyroid deficiencies, lupus, and seizures.

Osteoporosis can often go unnoticed as it progresses silently causing bone loss and affecting new bones with time. It is mostly diagnosed when a fracture occurs.

Older adults between the ages of 40 to 50 are at an increased risk of osteoporosis as they have crossed their prime time of bone formation. During these years, bones heal at a slower rate. Smokers, especially premenopausal women who smoke are hence, more prone to fracture risk due to osteoporosis. 

Read more interesting facts about osteoporosis here.


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How Does Smoking Cause Osteoporosis?

As mentioned earlier, studies indicate that smoking is considered a risk factor for osteoporosis. Smoking has already been proven to have a direct relationship with low bone density. It can affect the bone health of an individual of any age, weaken the bone tissue, and cause bone loss

Smoking affects your body’s ability to absorb calcium, leading to lower bone density and weaker bones. Nicotine slows the production of the bone-forming cells that are so crucial to healing. Tobacco causes an imbalance in bone turnover, leading to lower bone mass and making bone vulnerable to osteoporosis and fracture.

The prime time for bone growth as well as improving bone density is from childhood till the age of 30. Adolescents smokers have an increased risk of lesser bone density than non-smokers of the same age group. 

How Does Smoking Aggravate Osteoporosis:

Cigarette smoke contains about 7000 chemicals that are involved in premature death, various chronic diseases like chronic heart disease or chronic obstructive pulmonary disease, and even cancer. The free radicals in the smoke attack the body’s defense system. A chain of reactions leads to the destruction of essential components of the body, such as cells, organs, and hormones that regulate bone health.

Research studies reveal that tobacco interacts with the skeletal system- it upsets the balanced process of bone turnover,  leading to weaker bones with low bone mineral density and mass.

Tobacco and cigar

Tobacco causes adverse effects on bone density directly and indirectly. It directly hinders processes like angiogenesis and osteogenesis of bone. Nicotine and other free radicals in cigarette smoke kill osteoblasts which are bone-forming cells.

They also damage the blood vessels leading to a lack of oxygen supply. Due to brittle bones, smokers tend to have repeated fractures and even a small fall could lead to a hip fracture. In its advanced stages, osteoporosis could be fatal.

The healing period of a broken bone is also slower compared to a non-smoker as there is decreased supply of oxygen to the bone-forming cells. Along with blood vessel damage, excessive tobacco damages the nerves in the toes and feet, leading to an increased risk of falls and consequent fragility fractures.

Tobacco acts indirectly on bone density by altering body weight, sex hormones, adrenal hormones, PTH-vitamin D axis, and causes elevated oxidative stress on bone tissue. Estrogen in females is essential for reproduction and maintaining optimal bone health.

The toxins in cigarette smoke cause an imbalance in estrogen level and stimulate the liver to produce estrogen-destroying enzymes which speed up bone loss. This is detrimental in a postmenopausal woman with already deteriorating bone health.

Cortisol is a hormone that increases upon interaction with toxins found in cigarette smoke. It further enhances bone breakdown. Calcitonin is another hormone that is adversely affected by smoking. 


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Management Strategies for Osteoporosis

The first option for smokers to manage osteoporosis is to discard the habit. Putting an end to smoking always brings a positive change in an individual’s quality of life and health. The body starts to heal and bone strength increases. The earlier you stop smoking, the lesser your risk of low bone density and fracture risk as you age.

A study published in the Journal of Women’s health in 2006 revealed that a group of postmenopausal women had significant improvement in bone density after quitting smoking for a year. The results were compared with the women who continued smoking and this group was reported to have lesser bone density.

Nicotine Replacement Therapy:

Many programs help a person recover from cigarette addiction. Lozenges with nicotine, patches, gums, and prescription medicines are reliable resources to counter the addiction.

These products help the person fulfill the nicotine craving in a smoke-free way. Moreover, they are FDA-approved with the assurance that they are safe, effective, and with lesser side effects.

Nicotine patch

Chain smokers get addicted to nicotine and their body starts depending on it. The nicotine craving comes when the level of nicotine in the body decreases and withdrawals occur when the person is deprived of cigarettes. The withdrawal effects include depression, insomnia, and anxiety.

These effects can be effectively managed by nicotine replacement therapy. As the name indicates, nicotine replacement therapy provides the body the amount of nicotine required from products other than cigarettes such as lozenges, nicotine patches, and gums. The amount of nicotine can be gradually decreased till the person completely recovers from the withdrawal effects.


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Vitamin D and Calcium-rich Diet

Calcium plays a vital role in bone formation and its deficiency can lead to weak bones and bone loss. Vitamin D helps the body absorb calcium. Calcium and vitamin D combination is used to treat or prevent a calcium deficiency. You can maintain strong and healthy bones by consuming a diet rich in calcium and vitamin D.

Some good sources of calcium are dairy products with low fat, calcium-fortified food and drinks, and dark leafy vegetables whereas vitamin D can be obtained from egg yolks, liver, and fish.

The recommended amount of calcium and vitamin D increases as the individual crosses 50 as the bone loss occurs more rapidly at old age. Old age also decelerates the healing process. Therefore, the recommended calcium intake is 1000mg for people aged below. For women over 50 and men over 70 years of age, the recommended calcium intake is 1200mg daily.

The vitamin D intake recommended for older adults is 600-800IU every day.

Physical Exercise

Just like muscles, your bones are also positively impacted by increased physical activity. Sitting idle for prolonged periods of time can result in decreased bone mass and worsen bone health.

senior man running in a park

Weight-bearing exercises are recommended to increase bone strength and maintain the body’s peak bone mass. These include climbing stairs, walking, and dancing. Resistance exercises (weight-bearing exercises) like weight lifting are also effective for increased bone thickness. Tai chi and Yoga are also good for osteoporosis.


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Minimize Alcohol Consumption:

Excess alcohol upsets the calcium level in the body. It also interferes with the synthesis of hormones that safeguard the bones. In addition to this, alcohol also affects the vitamins that are needed to absorb calcium. Hence, it is necessary to cut down on alcohol to manage osteoporosis.

Bone density test

A bone density test helps you determine bone density in various regions of the body. It is a completely painless procedure that detects osteoporosis before the occurrence of a fracture.

BMD bone scan

A Dexa Scan can predict the fracture risk in the individual. A person who smokes or has a history of smoking can consult his/her healthcare provider regarding a bone density test. The correct diagnosis can help your doctor choose the most suitable method of treatment for reducing the consequences and help you live well with osteoporosis.


There is a variety of medicines available to treat osteoporosis. A postmenopausal woman with a history of smoking can consult her healthcare provider regarding her Bone density test and most suitable medicine.

At present, only the symptoms of osteoporosis can be managed, but there is no complete cure. There is extensive research as to whether osteoporosis can be reversed. In some research, CBD oil for osteoporosis is said to be beneficial for improving bone health.

Following the above-mentioned strategies can prevent and treat osteoporosis and are especially beneficial in the management of osteoporosis in the elderly.