Department of Medicine (DIMED), Geriatrics Division, University of Padua, Padua, Italy.
Department of Medicine (DIMED), Geriatrics Division, University of Padua, Padua, Italy.
J Clin Densitom. 2020 Jul-Sep;23(3):381-389. doi: 10.1016/j.jocd.2019.07.007. Epub 2019 Jul 10.
Smoking is recognized among the risk factors for osteoporosis, but only few studies have comprehensively explored its influence on bone metabolism and strength. We aimed to evaluate smoking effects on calcium-phosphate metabolism, bone mineral density (BMD) and fracture risk in postmenopausal women.
Our sample included 1067 postmenopausal women who arrived to our osteoporosis outpatient clinic. Anamnestic data, smoking habits (categorized as never, former, and current; and by smoking intensity and duration), biochemical parameters, lumbar/femoral BMD, and presence of vertebral fractures were recorded. In a subsample of 357 women, the changes in BMD after a 2-yr follow-up period were also assessed.
Current smokers had shorter reproductive age, lower body mass index, and higher prevalence of heavy alcohol consumption than former/never smokers. They also had lower PTH values and weaker linear association between serum vitamin D and parathyroid hormone (current β = -0.11[SE = 0.004]; former β = -0.14[SE = 0.01]; never β = -0.20[SE = 0.003]; p < 0.01 for all). Baseline BMD did not reflect differences based on smoking habits, duration or intensity. However, after 2 years, only current smokers significantly worsened in femural BMD. After adjustment for confounders, the chance of having sustained vertebral fractures at the first evaluation increased by 74% (95% confidence interval:1.07-2.83) in current compared with never smokers, especially among heavy smokers.
Smoking may negatively affect bone by inhibiting vitamin D-parathyroid hormone axis, reducing estrogen exposure, promoting risky health behaviors, and accelerating bone loss, especially at the femur. No significant differences were observed in these outcomes among former smokers, suggesting that quitting smoking has beneficial effects on bone health.
吸烟被认为是骨质疏松症的危险因素之一，但仅有少数研究全面探讨了其对骨代谢和骨强度的影响。我们旨在评估吸烟对绝经后女性钙磷代谢、骨密度（BMD）和骨折风险的影响。
我们的样本包括 1067 名绝经后女性，她们前往我们的骨质疏松症门诊就诊。记录了病史数据、吸烟习惯（分为从不、曾经和现在；以及吸烟强度和持续时间）、生化参数、腰椎/股骨 BMD 和椎体骨折的存在情况。在 357 名女性的亚样本中，还评估了 2 年随访期间 BMD 的变化情况。
与曾经/从不吸烟者相比，现在吸烟者的生殖年龄更短、体重指数更低、重度饮酒的患病率更高。他们的 PTH 值也较低，血清维生素 D 与甲状旁腺激素之间的线性关联也较弱（现在吸烟者的 β 值为-0.11[SE=0.004]；曾经吸烟者的 β 值为-0.14[SE=0.01]；从不吸烟者的 β 值为-0.20[SE=0.003]；所有 p 值均<0.01）。基线 BMD 不能反映基于吸烟习惯、持续时间或强度的差异。然而，2 年后，只有现在吸烟者的股骨 BMD 明显恶化。在调整了混杂因素后，与从不吸烟者相比，现在吸烟者在首次评估时发生持续性椎体骨折的几率增加了 74%（95%置信区间：1.07-2.83），尤其是重度吸烟者。
吸烟可能通过抑制维生素 D-甲状旁腺激素轴、减少雌激素暴露、促进危险的健康行为以及加速骨质流失来对骨骼产生负面影响，尤其是在股骨。曾经吸烟者在这些结果中没有观察到显著差异，这表明戒烟对骨骼健康有益。
