Centre for Bone and Arthritis Research, Institute of Medicine, Sahlgrenska Academy, Sahlgrenska University Hospital, Gothenburg, Sweden.
J Bone Miner Res. 2012 Oct;27(10):2189-97. doi: 10.1002/jbmr.1674.
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 ± SD, 0.020 ± 0.047 mg/cm(2) versus 0.043 ± 0.040 mg/cm(2) , p < 0.01) and lumbar spine (0.027 ± 0.062 mg/cm(2) versus 0.052 ± 0.065 mg/cm(2) , p = 0.04), and substantially greater decreases in aBMD at the total hip (-0.055 ± 0.058 mg/cm(2) versus -0.021 ± 0.062 mg/cm(2) , p < 0.01) and femoral neck (-0.077 ± 0.059 mg/cm(2) versus -0.042 ± 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 ± 4.3 mm(2) versus 11.5 ± 8.9 mm(2) , p = 0.03), and a larger decrement of trabecular volumetric BMD (vBMD) than nonsmokers (-13.9 ± 20.5 mg/mm(3) versus -4.1 ± 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.
先前的研究表明，吸烟与骨量减少和骨折风险增加有关，但没有发表过关于在骨量获得期间改变吸烟行为的纵向研究。本研究旨在通过一项 5 年的纵向、基于人群的 833 名 18 至 20 岁年轻男性的研究（基线），调查吸烟行为改变时骨密度和骨几何结构的发展情况。此外，我们旨在使用高分辨率外周定量计算机断层扫描（HR-pQCT），研究在 23 至 25 岁（5 年随访）时，当前吸烟与桡骨和胫骨小梁微结构参数之间的横断面关联。与非吸烟者相比，从基线开始吸烟的男性全身（平均±标准差，0.020±0.047 mg/cm2 与 0.043±0.040 mg/cm2，p<0.01）和腰椎（0.027±0.062 mg/cm2 与 0.052±0.065 mg/cm2，p=0.04）的骨密度（aBMD）增加量明显较小，而全身（-0.055±0.058 mg/cm2 与-0.021±0.062 mg/cm2，p<0.01）和股骨颈（-0.077±0.059 mg/cm2 与-0.042±0.070 mg/cm2，p<0.01）的 aBMD 降低量明显更大。与非吸烟者相比，在胫骨中，开始吸烟的受试者的皮质横截面积（CSA）增加量较小（8.1±4.3 mm2 与 11.5±8.9 mm2，p=0.03），而骨小梁容积 BMD（vBMD）减少量较大（-13.9±20.5 mg/mm3 与-4.1±13.9 mg/mm3，p<0.001）。在 5 年随访时的横断面分析（23-25 岁），吸烟者的胫骨骨小梁 vBMD 显著降低（7.0%，p<0.01），这是由于骨小梁厚度降低（8.9%，p<0.001）所致，这是通过 HR-pQCT 评估的。与非吸烟者相比。总之，这项研究首次报告称，在年轻成年期开始吸烟的男性，其在脊柱和髋部等临床重要部位的 aBMD 发育较差，这可能是由于骨小梁密度的增加性丧失和皮质 CSA 生长受损所致。
