Smoking is associated with impaired bone mass development in young adult men: A 5-year longitudinal study

Abstract

It has previously been shown that smoking is associated with reduced bone mass and increased fracture risk, but no longitudinal studies have been published investigating altered smoking behavior at the time of bone mass acquisition. The aim of this study was to investigate the development of bone density and geometry according to alterations in smoking behavior in a 5-year, longitudinal, population-based study of 833 young men, age 18 to 20 years (baseline). Furthermore, we aimed to examine the cross-sectional, associations between current smoking and parameters of trabecular microarchitecture of the radius and tibia, using high-resolution peripheral quantitative computed tomography (HR-pQCT), in young men aged 23 to 25 years (5-year follow-up). Men who had started to smoke since baseline had considerably smaller increases in areal bone mineral density (aBMD) at the total body (mean AE SD, 0.020 AE 0.047 mg/cm 2 versus 0.043 AE 0.040 mg/cm 2 , p < 0.01) and lumbar spine (0.027 AE 0.062 mg/cm 2 versus 0.052 AE 0.065 mg/cm 2 , p ¼ 0.04), and substantially greater decreases in aBMD at the total hip (À0.055 AE 0.058 mg/cm 2 versus À0.021 AE 0.062 mg/cm 2 , p < 0.01) and femoral neck (À0.077 AE 0.059 mg/cm 2 versus À0.042 AE 0.070 mg/cm 2 , p < 0.01) than men who were nonsmokers at both the baseline and follow-up visits. At the tibia, subjects who had started to smoke had a smaller increment of the cortical cross-sectional area (CSA) than nonsmokers (8.1 AE 4.3 mm 2 versus 11.5 AE 8.9 mm 2 , p ¼ 0.03), and a larger decrement of trabecular volumetric BMD (vBMD) than nonsmokers (À13.9 AE 20.5 mg/mm 3 versus À4.1 AE 13.9 mg/mm 3 , p < 0.001). In the cross-sectional analysis at follow-up (23-25 years of age), smokers had significantly lower trabecular vBMD at the tibia (7.0%, p < 0.01) due to reduced trabecular thickness (8.9%, p < 0.001), as assessed using HR-pQCT, than nonsmokers. In conclusion, this study is the first to report that men who start to smoke in young adulthood have poorer development of their aBMD at clinically important sites such as the spine and hip than nonsmokers, possibly due to augmented loss of trabecular density and impaired growth of cortical cross-sectional area. ß

The Tromsø Study: Fit Futures: a study of Norwegian adolescents’ lifestyle and bone health

“…Longitudinal studies of adolescent boys and girls in early adulthood have shown adverse effect of smoking [21,43]. In our study, smoking was negatively associated with BMD at the hip only in boys.…”

Childhood socioeconomic status and adult femoral neck bone strength: Findings from the Midlife in the United States Study

“…In fact, several studies have demonstrated the protective effects of physical activity over the life course on adult bone health [78], and the especially important role of physical activity in the growing years [79] and of competitive sports in early life in Swedish men [80]. There is similarly increasing evidence of the deleterious effects of smoking on bone health in general [81], and especially that of smoking in the teenage and young adult years on peak bone mass in European men [82,83]. Not all of the childhood SES association with adult bone strength in the femoral neck was explained by health behaviors in this study, suggesting that other mechanisms such as food choices and nutrition adequacy may also play a mechanistic role.…”

Cigarette smoking and musculoskeletal disorders

“…A five year longitudinal study investigated the development of bone density in a population of 833 young men (18-20 years), using high resolution peripheral Quantitative Computed Tomography. Men who had started smoking had considerably smaller increases in total body and lumbar spine BMC, and substantially greater decreases at the total hip and femoral neck, than men who were non smokers at both baseline and follow-up visits 5 . Epidemiological surveys on post-menopausal women show that smokers loose significantly more cortical bone than non smoking counterparts 6 .…”