Many of the health problems caused by the use of tobacco are well known. The Centers for Disease Control and Prevention reports that smoking-related illnesses cost Americans more than $75 billion each year. Cigarette smoking causes heart disease, lung and esophageal cancer, and chronic lung disease. Additionally, several research studies have identified smoking as a risk factor for osteoporosis and bone fracture.

Facts About Osteoporosis

Osteoporosis is a condition in which bones weaken and are more likely to fracture (break). Fractures from osteoporosis can result in pain, disability, and sometimes death. Osteoporosis is a major health threat for an estimated 44 million Americans, 68 percent of whom are women.

In addition to smoking, risk factors for developing osteoporosis include:

• being thin or having a small frame
• having a family history of the disease or of fractures after the age of 50
• being postmenopausal or having had an early menopause
• having an abnormal absence of menstrual periods
• using certain medications, including glucocorticoids, for a long time
• not getting enough calcium
• not getting enough physical activity
• drinking too much alcohol.

Osteoporosis can often be prevented. Osteoporosis is a “silent?disease: it can progress for many years without symptoms until a fracture occurs. It has been called “a pediatric (childhood) disease with geriatric (old age) consequences,?because building healthy bones in youth helps prevent osteoporosis and fractures later in life. However, it is never too late to adopt new habits for healthy bones.

Smoking and Osteoporosis

Cigarette smoking was first identified as a risk factor for osteoporosis more than 20 years ago. Recent studies have shown a direct relationship between tobacco use and decreased bone density. Analyzing the impact of cigarette smoking on bone health is complicated. It is hard to determine whether a decrease in bone density is due to smoking itself or to other risk factors common among smokers. For example, in many cases smokers are thinner than nonsmokers, tend to drink more alcohol, may be less physically active, and have poor diets. Women who smoke also tend to have an earlier menopause than nonsmokers. These factors place many smokers at an increased risk for osteoporosis apart from their tobacco use.

In addition, most studies on the effects of smoking suggest that smoking increases the risk of having a fracture. Not all studies have supported these findings, but the evidence is mounting. For example:

• The longer you smoke and the more cigarettes you consume, the greater your risk of fracture in old age.
• Smokers who fracture may take longer to heal than nonsmokers and may experience more complications during the healing process.
• Significant bone loss has been found in older women and men who smoke.
• At least one study suggests that exposure to second-hand smoke during youth and early adulthood may increase the risk of developing low bone mass.
• Women who smoke often produce less estrogen (a sex hormone) and tend to experience menopause earlier than nonsmokers, which may lead to increased bone loss.
• Quitting smoking appears to reduce the risk of low bone mass and fractures. However, it may take several years to lower a former smoker's risk.

Osteoporosis Management Strategies

Start by quitting: The best thing a smoker can do to protect his or her bones is to quit smoking. Smoking cessation, even later in life, may help limit smoking-related bone loss. There are many resources available to help you stop smoking, some of which are listed at the end of this fact sheet.

Eat a well-balanced diet rich in calcium and vitamin D: Good sources of calcium include low-fat dairy products; dark green, leafy vegetables; and calcium-fortified foods and beverages. Also, supplements can help ensure that you get adequate amounts of calcium each day. The Institute of Medicine recommends a daily calcium intake of 1,000 mg (milligrams) for men and women, increasing to 1,200 mg for those over age 50.

Vitamin D plays an important role in calcium absorption and bone health. Vitamin D can be obtained naturally through exposure to sunlight and through various foods and supplements. Food sources of vitamin D include egg yolks, saltwater fish, and liver. Some people may need vitamin D supplements to achieve the recommended intake of 400 to 800 IU (International Units) each day.

Exercise for your bone health: Like muscle, bone is living tissue that responds to exercise by becoming stronger. Weight-bearing exercise that forces you to work against gravity is the best exercise for bone.

Some examples include walking, stair climbing, dancing, and lifting weights. Regular exercise such as walking may help prevent bone loss and will provide many other health benefits.

Avoid excessive use of alcohol: Chronic alcohol use has been linked to an increase in fractures of the hip, spine, and wrist. Drinking too much alcohol interferes with the balance of calcium in the body. It also affects the production of hormones, which have a protective effect on bone; and of vitamins, which we need to absorb calcium. Excessive alcohol consumption can also lead to more falls and related fractures.

Talk to your doctor about a bone density test: Bone mineral density (BMD) tests measure bone density in various sites of the body. These tests can detect osteoporosis before a fracture occurs and can predict your chances of fracturing in the future. If you are a current or former smoker, you may want to ask your health care provider whether you are a candidate for a bone density test.

See if medication is an option for you: There is no cure for osteoporosis. However, there are several medications available for the prevention and treatment of the disease in postmenopausal women and men. Your doctor can help you decide whether medication might be right for you.

Smoking Cessation Resources

Smokefree.gov: Smokefree.gov, created by the National Cancer Institute, is designed to help you quit smoking. Different people need different resources as they try to quit. The information and professional assistance available on this Web site can help to support both your immediate and long-term needs as you become, and remain, a nonsmoker. Available at www.smokefree.gov.

Pathways to Freedom: Winning the Fight Against Tobacco: Intended for use by African Americans, this guide was produced by the U.S. Centers for Disease Control and Prevention in partnership with key segments of the African American community, including churches, service organizations, and educational institutions. The development and revision of this guide was inspired by national concern over the high smoking rates in the African American population and the absence of relevant materials. The guide addresses many issues that are specific to African Americans, such as targeted advertising campaigns and historical, cultural, and socioeconomic influences. This resource offers proven strategies for anyone who wants to quit; information on how friends and family can help; and ideas on how the community and its leaders can promote the value of living a tobacco-free life. Available at www.cdc.gov/tobacco/quit/pathways.htm or by calling 1-800-232-1311 to request a free copy.

A Breath of Fresh Air: Independence from Smoking: Produced by the National Women’s Health Information Center, this Internet-based education and support program focuses on smoking cessation for women. Information is also available in Spanish. Available at www.4woman.gov/QuitSmoking.

Kick the Smoking Habit: Written especially for Latino families, Kick the Smoking Habit is part of a series of bilingual booklets explaining steps people can take to reduce their risk of having a heart attack or stroke. Information is provided in a friendly style to help the reader dispel some common myths. Available at www.nhlbi.nih.gov/health/public/heart/other/sp_smok.htm or by calling 301-592-8573 or 240-629-3255 (TTY).

For Your Information

For updates and for any questions about any medications you are taking, please contact the U.S. Food and Drug Administration at 1-888-INFO-FDA (1-888-463-6332, a toll-free call) or visit their Web site at www.fda.gov.