Osteoporosis International

, Volume 23, Issue 8, pp 2081–2092

The effects of smoking on bone metabolism


DOI: 10.1007/s00198-012-1940-y

Cite this article as:
Yoon, V., Maalouf, N.M. & Sakhaee, K. Osteoporos Int (2012) 23: 2081. doi:10.1007/s00198-012-1940-y


Osteoporosis is a common, morbid and costly disorder characterized by deterioration in bone strength. Cigarette smoking is associated with reduced bone mineral density (BMD) and increased fracture risk. There are basic, clinical, and observational studies that define several of the underlying pathophysiologic mechanisms that predispose smokers to bone loss. Such mechanisms include alterations in calciotropic hormone metabolism and intestinal calcium absorption, dysregulation in sex hormone production and metabolism, alterations in adrenal cortical hormone metabolism and in the receptor activator of nuclear factor kappa-B (RANK), receptor activator of nuclear factor kappa-B ligand (RANKL), and osteoprotegerin (OPG) system (RANK–RANKL–OPG system), and direct cellular effects of cigarette use on bone cells. In addition, there is evidence of reversibility in the aforementioned mechanisms with smoking cessation. In summary, cigarette smoking is a reversible risk factor for osteoporosis and osteoporotic fractures through diverse pathophysiologic mechanisms.


OsteoporosisSmokingSmoking cessation

Copyright information

© International Osteoporosis Foundation and National Osteoporosis Foundation 2012

Authors and Affiliations

  1. 1.The Charles and Jane Pak Center for Mineral Metabolism and Clinical Research and Department of Internal MedicineUniversity of Texas Southwestern Medical CenterDallasUSA