Calcified Tissue International

, Volume 55, Issue 6, pp 403–407

Bone mineral density, sex steroids, and mineral metabolism in premenopausal smokers

  • N. Ortego-Centeno
  • M. Muñoz-Torres
  • J. Hernandez-Quero
  • A. Jurado-Duce
  • J. de la Higuera Torres-Puchol
Clinical Investigations


Smoking is related to decreased bone mass and increased risk of osteoporotic fractures. However, the harmful effects of smoking on bone have not been well characterized. The purpose of this study was to assess the repercussions of smoking on bone mass in premenopausal women, and the relationship between these effects and parameters of mineral metabolism and hormone profile. We measured bone mineral density (BMD) in 101 premenopausal women (47 smokers, 54 nonsmokers) with dualenergy X-ray absorptiometry (DeXA) of the proximal femur and lumbar spine. In a subgroup of the sample (16 smokers, 15 nonsmokers) we measured biochemical indicators of mineral metabolism and hormone profile. BMD in the femoral neck, Ward's triangle, and the intertrochanter region was significantly lower in smoker (P<0.05) than in nonsmokers. Concentrations of sex hormone-binding globulin were higher, and free testosterone index (FTI) was lower (P<0.05) in smokers. We found no significant differences between the groups in parameters of mineral metabolism. Concentrations of dehydroepiandrosterone sulfate and free testosterone index were directly correlated with values of BMD in different sites. Our findings show that smoking by premenopausal women is associated with decreased BMD and characteristic changes in the hormone profile.

Key words

Bone mineral density Smokers Premenopausal women Mineral metabolism Sex steroids 


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  1. 1.
    Daniell HW (1972) Osteoporosis and smoking. JAMA 221:509Google Scholar
  2. 2.
    Daniell HW (1976) Osteoporosis of the slender smokers. Vertebral compression fractures and loss of metacarpal cortex in relation to postmenopausal cigarette smoking and lack of obesity. Arch Int Med 136:298–395Google Scholar
  3. 3.
    Seeman E, Melton LJ III, O'Fallon WM, Riggs BL (1989) Risk factors for spinal osteoporosis in men. Am J Med 320:554–558Google Scholar
  4. 4.
    Aloia JP, Vasmani AN, Yeh JK (1983) Determinants of bone mass in postmenopausal women. Arch Intern Med 143:1700–1704Google Scholar
  5. 5.
    Williams AR, Weiss NS, Ure CL, Ballard J, Daling J (1982) Effect of weight, smoking and estrogen use on the risk of hip and forearm fractures in postmenopausal women. Obstet Gynecol 60:695–699Google Scholar
  6. 6.
    McNair, Christiansen MS, Madsbad S, Christiansen C, Binder C, Transbol I (1980) Bone loss in patients with diabetes mellitus. Effects of smoking. Min Elect Metab 3:94–97Google Scholar
  7. 7.
    Sparrow D, Rosner B, Garvey A, Silbert J (1982) The influence of cigarette and age on bone loss in women. Arch Environ Health 37:246–249Google Scholar
  8. 8.
    Stevenson JC, Lees B, Devenport M, Cust MP, Ganger KF (1989) Determinants of bone density in normal women: risk factors for future osteoporosis? Br Med J 298:924–928Google Scholar
  9. 9.
    Davis MC, Hall MC, Jacobs HAS (1990) Bone mineral loss in young women with amenorrhoea. Br Med J 301:790–793Google Scholar
  10. 10.
    Jensen GF (1986) Osteoporosis of the slender smokers revisited by epidemiologic approach. Eur J Clin Invest 16:239–242Google Scholar
  11. 11.
    McDermott MT, Witte MC (1988) Bone mineral content in smokers. South Med J 81:477–480Google Scholar
  12. 12.
    Daniel M, Martin AD, Drinkwater DT (1992) Cigarette smoking, steroid hormones, and bone mineral density in young women. Calcif Tissue Int 50:300–305Google Scholar
  13. 13.
    MacMahon E, Trichopaulos D, Cole P, Brown J (1982) Cigarette smoking and urinary estrogens. N Engl J Med 07:1062–1065Google Scholar
  14. 14.
    Michnovicz PJ, Herchcopf RJ, Naganuma H, Bradlow HL, Fishman J (1986) Increased 2-hydroxylation of estradiol as a possible mechanism for anti-estrogenic effect of cigarette smoking. N Engl J Med 315:1305–1309Google Scholar
  15. 15.
    De Vernejoul MC, Bielakoff J, Gueris J, Hott M, Modrovski D, Kuntz D, Miravet L, Ryckewaert A (1983) Evidence for defective osteoblastic function. A role for alcohol and tobacco consumption in osteoporosis in middle-aged men. Clin Orthop 179: 107–115Google Scholar
  16. 16.
    Fang MA, Frost PJ, Iida-Klein A, Hahn TJ (1991) Effects of nicotine on cellular function in UMR 106-01 osteoblast-like cells. Bone 12:283–286Google Scholar
  17. 17.
    Hollo I, Gergely I, Boross M (1987) Smoking results in calcitonin resistance. JAMA 237:2470Google Scholar
  18. 18.
    Belgorosky A, Escobar ME, Ravirola MA (1987) Validity of the calculation of non-sex hormone-binding globulin-bound estradiol from total testosterone, total estradiol and sex hormone-binding globulin concentrations in human serum. Steroid Biochem 28:429–432Google Scholar
  19. 19.
    Campos-Pastor MM, Muñoz-Torres M, Escobar-Jimenez E, Ruiz de Almodovar M, Jódar-Gimeno E (1993) Bone mass in females with different thyroid disorders: influence of menopausal status. Bone Miner 21:1–8Google Scholar
  20. 20.
    Slemenda C, Hui SL, Longcope C, Johnston CC (1989) Cigarette smoking, obesity, and bone mass. J Bone Miner Res 4: 737–741Google Scholar
  21. 21.
    Mazess RB, Barden HS (1991) Bone density in premenopausal women: effects of age, dietary intake, physical activity, smoking and birth control pills. Am J Clin Nutr 53:132–142Google Scholar
  22. 22.
    Krall EA, Dawson-Hughes B (1991) Smoking and bone loss among postmenopausal women. J Bone Miner Res 6:331–337Google Scholar
  23. 23.
    Pocock NA, Eisman JA, Kelly PJ, Smabrook PN, Yeates MG (1989) Effects of tobacco use on axial and appendicular bone mineral density. Bone 10:329–331Google Scholar
  24. 24.
    Ernster VL (1981) The epidemiology of benign breast disease. Epidemiol Rev 3:184–202Google Scholar
  25. 25.
    Berkowitz GS, Canny FP, Li Volsvi VA (1985) Cigarette smoking and benign breast disease. J Epidemiol Commun Health 39:308–313Google Scholar
  26. 26.
    Lesko SM, Rosenberg L, Kaufmar DN (1985) Cigarette smoking and the risk of endometrial cancer (1985) N Engl J Med 313:593–596Google Scholar
  27. 27.
    Kountmartaki Y, Tzonou A, Koumantakis E (1989) A case control study of cancer of endometrium in Athens. Int J Cancer 43:795–799Google Scholar
  28. 28.
    Nordin BEC, Need AG, Morris HA, Horrowitz M (1985) New approaches to the problems of osteoporosis. Clin Orthop 200: 181–197Google Scholar
  29. 29.
    Jensen J, Christiansen C, Rødbro P Cigarette smoking, serum estrogens and bone loss during hormone-replacement therapy after menopause. N Engl J Med 313:973–975Google Scholar
  30. 30.
    Daniell HW (1987) Anti-estrogenic effect of cigarette smoking. N Engl J Med 316:1342–1343Google Scholar
  31. 31.
    Kiel DP, Baron JA, Andersson J, Hannan MT, Felson DT (1992) Smoking eliminates the protective effect of oral estrogens on the risk for hip fracture among women. Ann Int Med 116: 716–721Google Scholar
  32. 32.
    Moore JW, Key TJA, Bulbrook RD, Clark GMG, Allen DS, Wang DY, Pike MC (1987) Sex hormone binding globulin and risk factor for breast cancer in a population of normal women who had never used exogenous sex hormones. Br J Obstet Gynecol 56:661–666Google Scholar
  33. 33.
    Nisker JA, Hammond GL, Siiters PK (1980) More on fatness and reproduction. N Engl J Med 303:1124Google Scholar
  34. 34.
    Vermeulen A, Verdonck L, Van Der Staten M, Orie N (1969) Capacity of the testosterone-binding globulin in human plasma and influence of specific binding of testosterone on its metabolic clearance rate. J Clin Endocrinol Metab 29:1470–1477Google Scholar
  35. 35.
    Buchanan JR, Hospodar P, Myers C, Leuenberg P, Demers LM (1988) Effect of excess endogenous androgens on bone density in young women. J Clin Endocrinol Metab 67:937–943Google Scholar
  36. 36.
    Preželj J, Kocijančič A (1993) Bone mineral density in hyperandrogenic amenorrhoea. Calcif Tissue Int 52:422–424Google Scholar
  37. 37.
    Steinberg KK, Freni-Titulaer LW, DePuey EG, Miller DT, Sgoutas DS, Coralli CH, Phillips DL, Rogers TN, Clark RV (1989) Sex steroids and bone density in premenopausal and perimenopausal women. J Clin Endocrinol Metab 69:533–539Google Scholar
  38. 38.
    Van Hemert AM, Birkenhäger JC, De Joung FH, Vanderbroucke JP, Valkenburg HA (1989) Sex hormone binding globulin in postmenopausal women: a predictor of osteoporosis superior to endogenous oestrogens. Clin Endocrinol 31:499–509Google Scholar

Copyright information

© Springer-Verlag New York Inc. 1994

Authors and Affiliations

  • N. Ortego-Centeno
    • 1
  • M. Muñoz-Torres
    • 2
  • J. Hernandez-Quero
    • 1
  • A. Jurado-Duce
    • 1
  • J. de la Higuera Torres-Puchol
    • 1
  1. 1.Servicio de Medicina Interna BHospital Universitario de GranadaGranadaSpain
  2. 2.Servicio de EndocrinologíaHospital Universitario de GranadaGranadaSpain

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