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Smoking and Your Bones

Can smoking harm bones?

Smoking is not only harmful to general health, but also a significant risk factor for osteoporosis and broken bones.

How does smoking harm bones?

More research is needed to fully understand the way smoking affects bones but it is known that smoking appears to have direct toxic effects on important cells that make bone called osteoblasts.

How does smoking affect bones over a lifetime?

  • Smoking during youth can prevent a person from reaching peak bone mass. Peak bone mass, defined as the maximum bone density (thickness) you will ever have, is reached by 25 years of age. You are less likely to develop osteoporosis later in life if you build larger, stronger bones (greater peak bone mass) in youth.
  • Smoking reduces estrogen levels in women, the female hormone that protects bones. Women who smoke often experience an earlier menopause (the permanent loss of menstrual periods) than non-smokers. An earlier menopause results in a woman having a longer amount of time without estrogen which may increase the risk for osteoporosis. At menopause, most women lose bone mass rapidly and smoking may lead to even greater losses.
  • As people age, both men and women who smoke tend to have more rapid bone loss and an increased risk of osteoporosis
  • Smoking in adulthood is associated with higher risk of broken bones. In older adults, smoking greatly increases the risk for hip fractures. Smoking is an independent risk factor for hip fracture; that means smokers may be at an increased risk for hip fracture even when bone density is normal. Smokers tend to have a poor quality of bone that is more likely to break than nonsmokers.
  • Smoking is a major risk factor for hip fracture in men and women. Generally, the healing process following hip fracture is slower among smokers than non-smokers. As per research, approximately 1 in 8 broken hips in older women are caused by smoking.

What can a smoker do to reduce the risk for osteoporosis?

  • To reduce your chances of getting osteoporosis, the risk of suffering a painful spine or hip fracture, and to improve the healing of a fracture; it is important to quit smoking. For example, women who stop smoking can cut their hip fracture risk in half after only 5 years. The good news is there is help to quit and it is free. By calling the New York State Smokers Quitline at 1-866-NY-QUITS (1-866-697-8487) or visiting the New York State Smoker’s Quitsite  you can find out how to quit smoking. The sooner you quit smoking, the better.
  • Don’t let osteoporosis sneak up on you, find out if a bone mineral density test (BMD test) is appropriate for you. A BMD test can measure the density of your bones and detect osteoporosis before a bone breaks. Postmenopausal women and men age 50 and older who currently smoke or have a recent history of smoking more than 1 pack per day should speak to their healthcare provider about getting a bone mineral density (BMD) test. It is important to assess your other risk factors for osteoporosis (besides smoking) by using the appropriate NYSOPEP Osteoporosis Risk Assessments. See “Osteoporosis Risk Assessment for Postmenopausal Women“, for “Premenopausal Women” or “for Men“. It is important to identify your risk factors for osteoporosis and discuss the ways to reduce your risks and optimize your bone health with your healthcare provider.  Ideally, you should begin bone healthy actions in childhood and continue them throughout your lifetime. It’s never too early or too late to take the actions to promote strong bones.

What are the actions that promote strong bones?

In addition to not smoking, the following actions can help build strong bones in youth and maintain bone mass in adulthood:

  • Eating a nutrient-rich diet including plenty of fruits and vegetables
  • Staying at a healthy weight; avoiding rapid weight loss and dieting to achieve excessive thinness
  • Choosing foods to get the calcium you need and adding a supplement only when necessary to get the recommended
    amount of calcium each day
  • Getting the recommended amount of vitamin D; this usually requires a supplement
  • Being physically active every day (for example: walking, climbing stairs, or dancing)
  • Limiting the amount of alcohol you drink; avoiding heavy drinking and underage drinking
  • Speaking to your healthcare provider about your bone health
  • Taking safety precautions to protect your bones and prevent falls

What if I am diagnosed with osteoporosis?

Treatment of osteoporosis should always include the above actions to promote strong bones. However, when osteoporosis is diagnosed, these important steps are usually not enough. Medication may be needed to stop further bone loss or to prevent fractures. For more information see
FDA-Approved Medications for Osteoporosis“.