Skeletal System Biology and Smoke Damage: From Basic Science to Medical Clinic

Abstract

Cigarette smoking has a negative impact on the skeletal system, as it reduces bone mass and increases fracture risk through its direct or indirect effects on bone remodeling. Recent evidence demonstrates that smoking causes an imbalance in bone turnover, making bone vulnerable to osteoporosis and fragility fractures. Moreover, cigarette smoking is known to have deleterious effects on fracture healing, as a positive correlation between the daily number of cigarettes smoked and years of exposure has been shown, even though the underlying mechanisms are not fully understood. It is also well known that smoking causes several medical/surgical complications responsible for longer hospital stays and a consequent increase in the consumption of resources. Smoking cessation is, therefore, highly advisable to prevent the onset of bone metabolic disease. However, even with cessation, some of the consequences appear to continue for decades afterwards. Based on this evidence, the aim of our review was to evaluate the impact of smoking on the skeletal system, especially on bone fractures, and to identify the pathophysiological mechanisms responsible for the impairment of fracture healing. Since smoking is a major public health concern, understanding the association between cigarette smoking and the occurrence of bone disease is necessary in order to identify potential new targets for intervention.

Probing combinational influence of design variables on bone biomechanical response around dental implant‐supported fixed prosthesis

“…The density of the bone is a commonly used indicator for indexing patients' bone quality 35 and it changes significantly during disease and/or as a function of various physiological and lifestyle variations. [37][38][39] In this study, the bone density of the mandible was approximately 1.76 ± 0.38 g/cc, which was about 5% below the value reported in literature 40 and therefore, considered as "normal" and used for calculating other "bone conditions." Thus, the bone density was varied ±20% to simulate different bone conditions.…”

“… As a result, since each individual element had a distinct ρ and E , the meshed mandible would have an inhomogeneous distribution of material properties, which was useful for better simulating the inherent patient‐specific nature of bone's material. The density of the bone is a commonly used indicator for indexing patients' bone quality 35 and it changes significantly during disease and/or as a function of various physiological and lifestyle variations 37–39 . In this study, the bone density of the mandible was approximately 1.76 ± 0.38 g/cc, which was about 5% below the value reported in literature 40 and therefore, considered as “normal” and used for calculating other “bone conditions.” Thus, the bone density was varied ±20% to simulate different bone conditions.…”

Current Status of the Diagnosis and Management of Osteoporosis

“…This also explains the early onset of menopause in female smokers, with the consequent effects of this condition on bone health [ 218 ]. However, it is unclear which of the toxins found in cigarettes are specifically related to the alteration of bone health [ 219 ].…”

“…Smoking also induces inflammatory processes and increases oxidative stress, generating damage to the collagen metabolism, which acts as an important biochemical marker in bone metabolism in addition to inducing toxicity on bone cells by increasing the resistance to calcitonin, which blocks bone angiogenesis [ 223 ], preventing the creation of new blood vessels, which would alter the flow of oxygen and nutrients to the bone [ 224 ]. In addition to the inverse association between smoking and body weight described in the evidence, it has been shown that cigarette consumption is associated with low weight due to the inhibitory effect of nicotine on appetite [ 219 ].…”

Metabolic Bone Diseases and New Drug Developments

“…MBDs are usually caused by an individual’s internal malformations in skeletal cellular components or by anomalies in calcium and phosphorus homoeostatic processes ( Bonakdarpour, 2009 ), with osteoporosis being the most common. A generalized decrease in bone mass results from an imbalance between the rates of osteogenesis and osteoclast, which can have numerous causes, the most significant of which is estrogen insufficiency in post-menopausal women ( Tarantino et al , 2021 ). Osteomalacia is a mineralization deficiency caused by the lack of calcium or phosphorus, or by deficient osteoblast activity ( Anderson et al , 2005 ).…”