Background Smoking is recognized as a risk factor for vertebral,forearm, and hip fractures. Since bone density is an importantdeterminant of bone strength, we conducted a study to ascertainwhether a deficit in bone density is associated with tobaccouse and, if so, to identify the responsible mechanisms.
Methods We conducted a cross-sectional study of bone densityat the lumbar spine and the femoral neck and shaft in 41 pairsof female twins (21 monozygotic pairs), 27 to 73 years of age(mean, 49), who were discordant for at least 5 pack-years ofsmoking (mean, 23; maximum, 64). Bone density was measured bydual-photon absorptiometry. The difference in bone density betweenthe members of a pair was expressed as a percentage of the meanvalue for the pair.
Results For every 10 pack-years of smoking, the bone densityof the twin who smoked more heavily was 2.0 percent lower atthe lumbar spine (P = 0.01), 0.9 percent lower at the femoralneck (P = 0.25), and 1.4 percent lower at the femoral shaft(P = 0.04). These results were not confounded by measured lifestylefactors. In the 20 pairs who were discordant by 20 or more pack-years(mean, 35), the (mean ±SE) within-pair differences inbone density at the three sites were 9.3 ±3.1 percent(P = 0.008), 5.8 ±2.9 percent (P = 0.06), and 6.5 ±3.2percent (P = 0.05), respectively. Smoking was associated withhigher serum concentrations of follicle-stimulating hormone(P = 0.02) and luteinizing hormone (P = 0.03) and lower serumconcentrations of parathyroid hormone (P = 0.05). Differencesin spinal bone density between members of a pair were associatedwith differences in the serum concentrations of parathyroidhormone (P = 0.01) and calcium (P = 0.05) and urinary pyridinolineexcretion (P = 0.06), a marker of bone resorption.
Conclusions Women who smoke one pack of cigarettes each daythroughout adulthood will, by the time of menopause, have anaverage deficit of 5 to 10 percent in bone density, which issufficient to increase the risk of fracture.
Source Information
From the Faculty of Medicine Epidemiology Unit, University of Melbourne, Carlton (J.L.H.), and the Endocrine Unit, Department of Medicine, Austin Hospital, University of Melbourne, Heidelberg (E.S.) -- both in Australia.
Address reprint requests to Dr. Seeman at the Endocrine Unit, Austin Hospital, Heidelberg, Victoria 3084, Australia.
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