Kiel D P, Zhang Y, Hannan M T, Anderson J J, Baron J A, Felson D T
Hebrew Rehabilitation Center for Aged Research and Training Institute, Boston, MA 02131, USA.
Osteoporos Int. 1996;6(3):240-8. doi: 10.1007/BF01622741.
To assess the effect of smoking on bone mineral density (BMD) at different life stages, to examine whether the effect of smoking differs between men and women, and to discover whether its effect in women differs according to history of estrogen use, a cohort study was carried out with single cross-section measurement of BMD by single and dual photon absorptiometry. The setting was the Framingham Study, a population-based cohort study with over 40 years prospectively collected data on smoking. Subjects (n = 1164) consisted of cohort members participating in the 20th biennial Framingham examination (1988-1989). The measurements included in the study were BMD measured at the hip, spine and radius, smoking history ascertained at all Framingham Study examinations since 1948, and other factors affecting BMD (age, weight, estrogen use, caffeine use, alcohol use and physical activity). Neither current smoking, recent (last 10 years) smoking, nor early adulthood smoking resulted in significantly lower BMD at any skeletal site among women who had not taken estrogen. Among women who had taken estrogen, BMD at most sites was lower among current or recent smokers, although the small numbers of smokers made it difficult to find significant differences at all skeletal sites. Among men, a consistently lower BMD at all skeletal sites was observed for smokers regardless of when in their life they smoked (4-15.3% lower), although the effect of smoking during early adulthood was of a lesser magnitude (4-8% lower). Former male smokers who had quit < 10 years ago had lower BMD than men who had quit > or = 10 years ago. In conclusion, in women who had used estrogen, BMD was lower in current or recent smokers than it was in non-smokers. In men, smoking at any stage of life had adverse effects on the skeleton that was independent of weight, alcohol or caffeine use, implying other mechanisms for smoking's effect on bone.
为评估吸烟在不同生命阶段对骨密度（BMD）的影响，研究吸烟对男性和女性的影响是否存在差异，以及探究吸烟对女性的影响是否因雌激素使用史不同而有所差异，开展了一项队列研究，采用单光子吸收法和双能光子吸收法对BMD进行单次横断面测量。研究背景为弗明汉姆研究，这是一项基于人群的队列研究，前瞻性收集了40多年的吸烟数据。研究对象（n = 1164）为参与第20次弗明汉姆两年一度检查（1988 - 1989年）的队列成员。研究测量内容包括髋部、脊柱和桡骨的BMD测量，自1948年以来在所有弗明汉姆研究检查中确定的吸烟史，以及其他影响BMD的因素（年龄、体重、雌激素使用、咖啡因摄入、酒精摄入和身体活动）。在未使用雌激素的女性中，当前吸烟、近期（过去10年）吸烟或成年早期吸烟均未导致任何骨骼部位的BMD显著降低。在使用过雌激素的女性中，当前或近期吸烟者多数部位的BMD较低，尽管吸烟者数量较少，难以在所有骨骼部位发现显著差异。在男性中，无论其在生命中的何时吸烟，吸烟者所有骨骼部位的BMD均持续较低（低4 - 15.3%），尽管成年早期吸烟的影响程度较小（低4 - 8%）。戒烟时间不足10年的 former 男性吸烟者的BMD低于戒烟时间≥10年的男性。总之，在使用过雌激素的女性中，当前或近期吸烟者的BMD低于非吸烟者。在男性中，生命中任何阶段吸烟都会对骨骼产生不良影响，且这种影响独立于体重、酒精或咖啡因摄入，这意味着吸烟对骨骼的影响存在其他机制。
