Osteoporosis International

, Volume 24, Issue 4, pp 1339–1346 | Cite as

Dose-related effect of urinary cotinine levels on bone mineral density among Korean females

  • J.-P. Myong
  • H.-R. KimEmail author
  • S. E. Choi
  • J.-W. Koo
Original Article



To evaluate the dose-dependent relationship between smoking and bone mineral density (BMD), the present study used the BMD dataset of the Korean National Health and Nutrition Examination Survey IV (KNHANES IV). The linearity of BMD for urinary cotinine levels was demonstrated with statistical significance in postmenopausal females.


It is well established that smoking is an important lifestyle risk factor for bone health (bone loss, osteoporosis, and fracture). However, several studies demonstrated conflicting evidence for a dose-dependent relationship between smoking and bone health. To evaluate the dose-dependent relationship between smoking and BMD, the present study estimated dose-related effects of smoking (urinary cotinine level) on BMD at various sites (femur neck, total femur, and lumbar spine) in females with controlling menopausal status.


The present study used the BMD dataset of the KNHANES IV, which was performed in 2008 and 2009. A total of 4,260 pre- and postmenopausal females were included in the present study. Dose–response relationships between BMD and urinary cotinine levels were estimated using analysis of covariance in pre-menopausal females and postmenopausal females, respectively.


In postmenopausal females, the regression coefficients for BMD with urinary cotinine levels were −0.006, −0.006, and −0.008 (g/cm2 per ng/ml) at femur neck, total femur, and lumbar spine, respectively (p value < 0.05). Thus, the linearity of BMD for urinary cotinine levels was demonstrated with statistical significance in postmenopausal females.


Our findings suggested a significant dose-related effect of urinary cotinine level with BMD at femur neck, total femur, and lumbar spine among postmenopausal females.


Biomarker Bone density Cotinine KNHANES Smoking 


Conflicts of interest



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Copyright information

© International Osteoporosis Foundation and National Osteoporosis Foundation 2012

Authors and Affiliations

  • J.-P. Myong
    • 1
  • H.-R. Kim
    • 1
    Email author
  • S. E. Choi
    • 2
  • J.-W. Koo
    • 1
  1. 1.Department of Preventive Medicine, Center for Occupational and Environmental Medicine, College of MedicineThe Catholic University of KoreaSeoulRepublic of Korea
  2. 2.Program in Nursing Science, College of Health SciencesUniversity of CaliforniaIrvineUSA

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