The impact of E-cigarette vaping and vapour constituents on bone health

Abstract

Background In contrast to cigarettes, electronic cigarette use (E-cigarettes) has grown substantially over the last decade. This is due to their promotion as both a safer alternative to cigarettes and as an aide to stop smoking. Critically, upon E-cigarette use, the user may be exposed to high doses of nicotine in addition to other compounds including flavouring chemicals, metal particulates and carbonyl compounds, particularly in highly vascularised tissues such as bone. However, there has been limited investigation into the impact of E-cigarette usage on bone physiology, particularly over extended time periods and there are no clinical recommendations regarding E-cigarette usage in relation to orthopaedic surgery. This literature review draws together data from studies that have investigated the impact of E-cigarette vapour and its major constituents on bone, detailing the models utilised and the relevant mechanistic and functional results. Main body Currently there is a lack of studies both in vivo and in vitro that have utilised E-cigarette vapour, necessary to account for changes in chemical composition of E-cigarette liquids upon vaping. There is however evidence that human bone and bone cells express nicotine receptors and exposure of both osteoblasts and osteoclasts to nicotine, in high concentrations may reduce their viability and impair function. Similarly, it appears that aldehydes and flavouring chemicals may also negatively impact osteoblast viability and their ability to form bone. However, such functional findings are predominantly the result of studies utilising bone cell lines such as MG-63 or Saos-2 cells, with limited use of human osteoblasts or osteoclasts. Additionally, there is limited consideration for a possible impact on mesenchymal stem cells, which can also play an import role in bone repair. Conclusion Understanding the function and mechanism of action of the various components of E-cigarette vapour in mediating human bone cell function, in addition to long term studies to determine the potential harm of chronic E-cigarette use on human bone will be important to inform users of potential risks, particularly regarding bone healing following orthopaedic surgery and injury.

Osteosarcopenia in Patients with Chronic Obstructive Pulmonary Diseases: Which Pathophysiologic Implications for Rehabilitation?

“…The mechanisms underpinning the negative bond between osteoporosis and smoking are not fully understood. Beyond the widely documented proinflammatory effects of smoke that might indirectly affect bone health, a direct effect of tobacco smoking has also been described [ 96 ]. In particular, nicotine might directly reduce both osteogenesis and angiogenesis, which have a key role in bone metabolism [ 97 ].…”

“…In particular, nicotine might directly reduce both osteogenesis and angiogenesis, which have a key role in bone metabolism [ 97 ]. In addition, tobacco smoking has been related to altered intestinal permeability, and calcium absorption improves blood acidity, leading to higher bone turnover, and alterations in bone collagen synthesis [ 96 ]. Moreover, vitamin D deficiency and increased alcohol intake are commonly found in smokers, and oestrogen synthesis is also decreased [ 69 , 95 ].…”

Low Lung Function Is Associated with Low Baseline Calcaneus Ultrasound T-Score but a Slow Decline in T-Score in a Taiwanese Follow-Up Population with No History of Smoking, Bronchitis, Emphysema, or Asthma

“…Mechanisms of the negative relationship between osteoporosis and smoking are not well understood. The well-known proinflammatory effect of tobacco smoke may affect bone health both directly and indirectly [ 39 ]. In addition, nicotine has been reported to potentially directly reduce both osteogenesis and angiogenesis, which play key roles in bone metabolism [ 18 ].…”

Impact of Electronic Cigarettes on the Upper Aerodigestive Tract: A Comprehensive Review for Otolaryngology Providers

“…Significant headway has been made in assessing the effect of e‐cig components on the respiratory and cardiovascular systems, 16 , 17 , 18 , 19 , 20 , 21 , 22 and the number of studies exploring the effects of e‐cigs on other organ systems has also recently grown. 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 …”

“…On PubMed alone, the number of published articles on e‐cigs has increased from 372 in 2014 to 1132 in 2021 and there are hundreds of review papers on various aspects of e‐cig use. Significant headway has been made in assessing the effect of e‐cig components on the respiratory and cardiovascular systems, 16‐22 and the number of studies exploring the effects of e‐cigs on other organ systems has also recently grown 23‐46 …”