Effect of Cigarette Smoking on Risk of Hip Fracture in Men: A Meta-Analysis of 14 Prospective Cohort Studies

Abstract

BackgroundSeveral observational studies have suggested an association between cigarette smoking and risk of hip fracture. However, no formal systematic review or meta-analysis was performed to summarize this risk in men.Materials and MethodsA search was applied to MEDLINE, EMBASE, and web of science (up to November 1 2016). All prospective cohort studies assessing risk of hip fracture with the factor of cigarette smoking in men without language restriction were reviewed, and qualities of all included studies were assessed using the Newcastle-Ottawa Scale. Two authors independently assessed literatures and extracted information eligibility, and any disagreement was resolved by consensus. Newcastle-Ottawa quality assessment scale was used to evaluate studies’ quality in meta-analyses. We calculated the RR with 95% CIs in a random-effects model as well as the fixed-effects model using the metan command in the STATA version 12.0 (StataCorp, USA).ResultsFourteen prospective cohort studies were eligible for the present analysis. A meta-analysis of 12 prospective studies showed that the relative risk (RR) for current male smoking was 1.47 [95% confidence interval (CI) (1.28–1.66), p = 0.54; I2 = 0%]. Subgroup analyses show study characteristics (including geography region, length of follow-up, size of cohorts and study quality) did not substantially influence these positive associations. Eight studies reported the RRs for former smokers compared with never smokers and the pooled RR was 1.15 [95% CI, (0.97–1.34), (I2 = 0%, p = 0.975)].ConclusionsThe present meta-analysis of 14 prospective studies suggests that, compared with never smokers, cigarette smoking increases risk of hip fracture in man, specifically in current smokers. However, further larger prospective cohorts with more power or meta-analysis of individual patient data are needed to confirm this association.

Smoking and Alcohol Intake but Not Muscle Strength in Young Men Increase Fracture Risk at Middle Age: A Cohort Study Linked to the Swedish National Patient Registry

“…We did find a positive gradient in the association between smoking and fracture risk, with a 17% to 44% increased hazard of fracture among those men who reported smoking at least 6 and 21+ cigarettes per day, respectively, which is in accordance to what has been previously published . Our baseline data were collected among young adults, mostly aged 18, and therefore while bone is still building up.…”

“…We did find a positive gradient in the association between smoking and fracture risk, with a 17% to 44% increased hazard of fracture among those men who reported smoking at least 6 and 21+ cigarettes per day, respectively, which is in accordance to what has been previously published. (18)(19)(20)(21) Our baseline data were collected among young adults, mostly aged 18, and therefore while bone is still building up. There is evidence that in young men, smoking is associated with thinner cortex (30) and slower formation of peak bone mass; (31) therefore, our results suggest that smoking at this age could have long-term effects in fracture risk.…”

“…(20) Afterwards, evidence has been piling up linking smoking with fractures in men. (18,19,21) The association with alcohol is less consistent; although hip fracture risk appears to decrease among those consuming up to one drink per day compared with abstainers and with heavy drinkers, the same is not reported for other fracture sites. Moreover, the association between alcohol and bone mineral density differs by sex.…”

“…In 2005, a meta‐analysis found that smoking conferred and increased risk of fracture, which was more pronounced in men . Afterwards, evidence has been piling up linking smoking with fractures in men . The association with alcohol is less consistent; although hip fracture risk appears to decrease among those consuming up to one drink per day compared with abstainers and with heavy drinkers, the same is not reported for other fracture sites.…”

Impact of Smoking on Clinical Outcomes of Open Arthrolysis for Post-Traumatic Elbow Stiffness

“…Recently, great attentions have been paid to the relationship between smoking and orthopedic surgery outcomes, such as total joint arthroplasty [24], osteoarthritis [25], fractures [26], ligament reconstruction [27], and most of them showed negative effects of smoking on postoperative outcomes.…”