Skip to main content
SpringerLink
Log in

Cigarette smoking, sex hormones and bone density in women

  • Published:
European Journal of Epidemiology Aims and scope Submit manuscript

Abstract

It is known that among women over the age of 65, bone mineral density is lower, and the risk of hip fracture higher, in smokers than non-smokers. We report a study in 1334 health pre- and postmenopausal women aged 35–64 years, to determine whether this effect can be attributed to lower oestrogen levels in smokers. Among 676 premenopausal women forearm bone density was no lower in smokers (95% confidence interval 1% lower, 4% higher). Among 543 postmenopausal women who had not used hormone replacement therapy (HRT) for more than a year there was no statistically significant difference, but the lower confidence interval was consistent with a lower bone density in older smokers (by 8% at age 55–59, 16% at age 60–64). Measurements in 194 postmenopausal women not taking HRT showed that oestrone and oestradiol were similar in smokers and non-smokers, as were cortisol and FSH, LH and prolactin. Meta-analysis of the present study and previous studies confirmed significantly higher levels in smokers of the androgens DHEAS (by 37%) and androstenedione (by 34%). Oestrogens were no lower in smokers, and the lower confidence limit excluded more than a trivial effect of smoking in lowering oestrogen. These results indicate that the recognised lower bone density in elderly smokers cannot be explained by an effect of smoking on oestrogen, since in premenopausal women bone density is no lower in smokers and in postmenopausal women oestrogens are no lower in smokers. The data suggest a balance between higher androgen levels but lower rates of conversion of androgens to oestgrogens in smokers. The effect of smoking on bone may be due to impaired response of bone and other target organs to oestrogen, or to actions independent of oestrogen.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Baron JA, La Vecchia C, Levi F. The antiestrogenic effect of cigarette smoking in women. Am J Obstet Gynecol 1990; 162: 502–514.

    Google Scholar 

  2. Barbeieri RL, Gochberg J, Ryan KJ. Nicotine, cotinine, and anabasine inhibit aromatase in human trophoblast in vitro. J Clin Invest 1986; 77: 1727–1733.

    Google Scholar 

  3. Michnovicz JJ, Hershcopf RJ, Naganuma H, Bradlow HL, Fishman J. Increased 2-hydroxylation of estradiol as a possible mechanism for the anti-estrogenic effect of cigarette smoking. New Engl J Med 1986; 315: 1305–1309.

    Google Scholar 

  4. Bauer CC, Browner WS, Cauley JA, et al. Factors associated with appendicular bone mass in older women. Ann Intern Med 1993; 118: 657–665.

    Google Scholar 

  5. Rundgren Å, Mellström D. The effect of tobacco smoking on the bone mineral content of the ageing skeleton. Mech Ageing Dev 1984; 28: 273–277.

    Google Scholar 

  6. Hollenbach KA, Barrett-Connor E, Edelstein SL, Holbrook T. Cigarette smoking and bone mineral density in older men and women. Am J Public Health 1993; 83: 1265–1270.

    Google Scholar 

  7. Reed MJ, Change RW, Noel CT, Dudley HAF, James VHT. Plasma levels of estrone, estrone sulfate, and estradiol and the percentage of unbound estradiol in postmenopausal women with and without breast disease. Cancer Res 1983; 43: 3940–3943.

    Google Scholar 

  8. Knight GJ, Wylie P, Holman MS, Haddow JE. Improved 125-I radioimmunoassay for cotinine by selective removal of bridge antibodies. Clin Chem 1985; 31: 118–121.

    Google Scholar 

  9. Fehily AM, Coles RJ, Evans WD, Elwood PC. Factors affecting bone density in young adults. Am J Clin Nutr 1992; 56: 579–586.

    Google Scholar 

  10. Välimäki MJ, Kärkkäinen M, Lamberg-Allardt C, et al. Exercise, smoking, and calcium intake during adolescence and early adulthood as determinants of peak bone mass. BMJ 1994; 309: 230–235.

    Google Scholar 

  11. Ortego-Centeno N, Muñoz-Torres M, Hernandez-Quero J, Durado-Duce A, de la Higuera Torres-Buchol J. Bone mineral density, sex steroids, and mineral metabolism in premenopausal smokers. Calcif Tissue Int 1994; 55: 403–407.

    Google Scholar 

  12. McCulloch RG, Bailey DA, Houston CS, Dodd BL. Effects of physical activity, dietary calcium intake and selected lifestyle factors on bone density in young women. Can Med Assoc J 1990; 142: 221–227.

    Google Scholar 

  13. Daniel M, Martin AD, Drinkwater DT. Cigarette smoking, steroid hormones, and bone mineral density in young women. Calcif Tissue Int 1992; 50: 300–305.

    Google Scholar 

  14. Mazess RB, Barden HS. Bone density in premenopausal women: Effects of age, dietary intake, physical activity, smoking, and birth-control pills. Am J Clin Nutr 1991; 53: 132–142.

    Google Scholar 

  15. Sowers MR, Clark MK, Hollis B, Wallace RB, Jannausch M. Radial bone mineral density in pre-and perimenopausal women: A prospective study of rates and risk factors for loss. J Bone Miner Res 1992; 7: 647–657.

    Google Scholar 

  16. Johnell O, Nilsson BE. Life-style and bone mineral mass in perimenopausal women. Calcif Tissue Int 1984; 36: 354–356.

    Google Scholar 

  17. Jensen J, Christiansen C, Rødbro P. Cigarette smoking, serum estrogens, and bone loss during hormone-replacement therapy early after menopause. N Engl J Med 1985; 313: 973–975.

    Google Scholar 

  18. Jensen J, Christiansen C. Effects of smoking on serum lipoproteins and bone mineral content during post-menopausal hormone replacement therapy. Am J Obstet Gynecol 1988; 159: 820–825.

    Google Scholar 

  19. Slemenda CW, Hui SL, Longcope C, Johnston CC. Cigarette smoking, obesity, and bone mass. J Bone Miner Res 1989; 4: 737–741.

    Google Scholar 

  20. McDermott MT, Witte MC. Bone mineral content in smokers. South Med J 1988; 81: 477–480.

    Google Scholar 

  21. Sowers MF, Wallace RB, Lemke JH. Correlates of mid-radius bone density among postmanpausal women: A community study. Am J Clin Nutr 1985; 41: 1045–1053.

    Google Scholar 

  22. Krall EA, Dawson-Hughes B. Smoking and bone loss among postmenopausal women. J Bone Miner Res 1991; 6: 331–338.

    Google Scholar 

  23. Schlemmer A, Jensen J, Riis BJ, Christiansen C. Smoking induces increased androgen levels in early post-menopausal women. Maturitas 1990; 12: 99–104.

    Google Scholar 

  24. Longcope C, Johnston CC. Androgen and estrogen dynamics in pre-and postmenopausal women: A comparison between smokers and nonsmokers. J Clin Endrocrinol Metabl 1988; 67: 379–383.

    Google Scholar 

  25. Friedman AJ, Ravnikar VA, Barbieri RL. Serum steroid hormone profiles in postmenopausal smokers and nonsmokers. Fertil Steril 1987; 47: 398–401.

    Google Scholar 

  26. Key TJA, Pike MC, Baron JA, et al. Cigarette smoking and steroid hormones in women. J Steroid Biochem Mol Biol 1991; 39: 529–534.

    Google Scholar 

  27. Cauley JA, Gutai JP, Kuller LH, LeDonne D, Powell JG. The epidemiology of serum sex hormones in postmenopausal women. Am J Epidemiol 1989; 129: 1120–1131.

    Google Scholar 

  28. Cassidenti DL, Vijod AG, Vijod MA, Stanczyk FZ, Lobo RA. Short-term effects of smoking on the pharmacokinetic profiles of micronized estradiol in postmenopausal women. Am J Obstet Gynecol 1990; 163: 1953–1960.

    Google Scholar 

  29. Austin H, Drews C, Partridge EE. A case-control study of endometrial cancer in relation to cigarette smoking, serum estrogen levels, and alcohol use. Am J Obstet Gynecol 1993; 169: 1086–1091.

    Google Scholar 

  30. Baron JA, Comi RJ, Cryns V, Brinck-Johnsen T, Mercer NG. The effect of cigarette smoking on adrenal cortical hormones. J Pharmacol Exp Ther 1995; 272: 151–155.

    Google Scholar 

  31. Khaw K-T, Tazuke S, Barrett-Connor E. Cigarette smoking and levels of adrenal androgens in postmenopausal women. New Engl J Med 1988; 318: 1705–1709.

    Google Scholar 

  32. Cassidenti DL, Pike MC, Vijod AG, Stanczyk FZ, Lobo RA. A reevaluation of estrogen status in postmenopausal women who smoke. Am J Obstet Gynecol 1992; 166: 1444–1448.

    Google Scholar 

  33. Riebel GD, Boden SD, Whitesides TE, Hutton WC. The effect of nicotine on incorporation of cancellous bone graft in an animal model. Spine 1995; 20: 2198–2202.

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. BUDA Epidemiological Research Group, Department of Environmental and Preventive Medicine, Wolfson Institute of Preventive Medicine, St Bartholomew's and The Royal London School of Medicine, London, UK

    M.R. Law, R. Cheng & A.K. Hackshaw

  2. BUPA Medical Research, London, UK

    S. Allaway & A.K. Hale

Authors
  1. M.R. Law
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. R. Cheng
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. A.K. Hackshaw
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. S. Allaway
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. A.K. Hale
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Law, M., Cheng, R., Hackshaw, A. et al. Cigarette smoking, sex hormones and bone density in women. Eur J Epidemiol 13, 553–558 (1997). https://doi.org/10.1023/A:1007389712487

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1023/A:1007389712487

Search

Navigation