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

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Abstract

Summary

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.

Introduction

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.

Methods

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.

Results

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.

Conclusion

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.

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References

  1. Law MR, Hackshaw AK (1997) A meta-analysis of cigarette smoking, bone mineral density and risk of hip fracture: recognition of a major effect. BMJ 315:841–846

    Article  PubMed  CAS  Google Scholar 

  2. Waugh EJ, Lam MA, Hawker GA, McGowan J, Papaioannou A, Cheung AM, Hodsman AB, Leslie WD, Siminoski K, Jamal SA (2009) Risk factors for low bone mass in healthy 40-60 year old women: a systematic review of the literature. Osteoporos Int 20:1–21

    Article  PubMed  CAS  Google Scholar 

  3. Wong PK, Christie JJ, Wark JD (2007) The effects of smoking on bone health. Clin Sci (Lond) 113:233–241

    Article  CAS  Google Scholar 

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

    Article  PubMed  CAS  Google Scholar 

  5. Flicker L, Hopper JL, Rodgers L, Kaymakci B, Green RM, Wark JD (1995) Bone density determinants in elderly women: a twin study. J Bone Miner Res 10:1607–1613

    Article  PubMed  CAS  Google Scholar 

  6. Jones G, Nguyen T, Sambrook P, Kelly PJ, Eisman JA (1994) Progressive loss of bone in the femoral neck in elderly people: longitudinal findings from the Dubbo osteoporosis epidemiology study. BMJ 309:691–695

    Article  PubMed  CAS  Google Scholar 

  7. MacInnis RJ, Cassar C, Nowson CA, Paton LM, Flicker L, Hopper JL, Larkins RG, Wark JD (2003) Determinants of bone density in 30- to 65-year-old women: a co-twin study. J Bone Miner Res 18:1650–1656

    Article  PubMed  CAS  Google Scholar 

  8. Nguyen TV, Kelly PJ, Sambrook PN, Gilbert C, Pocock NA, Eisman JA (1994) Lifestyle factors and bone density in the elderly: implications for osteoporosis prevention. J Bone Miner Res 9:1339–1346

    Article  PubMed  CAS  Google Scholar 

  9. Jung-Choi KH, Khang YH, Cho HJ (2011) Hidden female smokers in Asia: a comparison of self-reported with cotinine-verified smoking prevalence rates in representative national data from an Asian population. Tob Control. doi:10.1136/tobaccocontrol-2011-050012

  10. Benson BW, Shulman JD (2005) Inclusion of tobacco exposure as a predictive factor for decreased bone mineral content. Nicotine Tob Res 7:719–724

    Article  PubMed  CAS  Google Scholar 

  11. Hu JF, Zhao XH, Chen JS, Fitzpatrick J, Parpia B, Campbell TC (1994) Bone density and lifestyle characteristics in pre-menopausal and postmenopausal Chinese women. Osteoporos Int 4:288–297

    Article  PubMed  CAS  Google Scholar 

  12. Korea Center for Disease Control and Prevention (2011) Korea National Health and Nutrition Examination Survey. http://knhanes.cdc.go.kr/. Accessed 5 March 2012 (in Korean)

  13. Haufroid V, Lison D (1998) Urinary cotinine as a tobacco-smoke exposure index: a minireview. Int Arch Occup Environ Health 71:162–168

    Article  PubMed  CAS  Google Scholar 

  14. SRNT Subcommittee on Biochemical Verification (2002) Biochemical verification of tobacco use and cessation. Nicotine Tob Res 4:149–159

    Article  Google Scholar 

  15. Brot C, Jorgensen NR, Sorensen OH (1999) The influence of smoking on vitamin D status and calcium metabolism. Eur J Clin Nutr 53:920–926

    Article  PubMed  CAS  Google Scholar 

  16. Krall EA, Dawson-Hughes B (1999) Smoking increases bone loss and decreases intestinal calcium absorption. J Bone Miner Res 14:215–220

    Article  PubMed  CAS  Google Scholar 

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

    Article  PubMed  CAS  Google Scholar 

  18. Barbieri RL, Gochberg J, Ryan KJ (1986) Nicotine, cotinine, and anabasine inhibit aromatase in human trophoblast in vitro. J Clin Invest 77:1727–1733

    Article  PubMed  CAS  Google Scholar 

  19. Tanko LB, Christiansen C (2004) An update on the antiestrogenic effect of smoking: a literature review with implications for researchers and practitioners. Menopause 11:104–109

    Article  PubMed  Google Scholar 

  20. Jarvinen TL, Kannus P, Sievanen H (2003) Estrogen and bone—a reproductive and locomotive perspective. J Bone Miner Res 18:1921–1931

    Article  PubMed  Google Scholar 

  21. Suzuki T (2001) Risk factors for osteoporosis in Asia. J Bone Miner Metab 19:133–141

    Article  PubMed  CAS  Google Scholar 

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

    PubMed  CAS  Google Scholar 

  23. Law MR, Cheng R, Hackshaw AK, Allaway S, Hale AK (1997) Cigarette smoking, sex hormones and bone density in women. Eur J Epidemiol 13:553–558

    Article  PubMed  CAS  Google Scholar 

  24. Mazess RB, Barden HS (1991) Bone density in pre-menopausal women: effects of age, dietary intake, physical activity, smoking, and birth-control pills. Am J Clin Nutr 53:132–142

    PubMed  CAS  Google Scholar 

  25. McCulloch RG, Bailey DA, Houston CS, Dodd BL (1990) Effects of physical activity, dietary calcium intake and selected lifestyle factors on bone density in young women. CMAJ 142:221–227

    PubMed  CAS  Google Scholar 

  26. Ortego-Centeno N, Munoz-Torres M, Hernandez-Quero J, Jurado-Duce A, de la Higuera T-PJ (1994) Bone mineral density, sex steroids, and mineral metabolism in pre-menopausal smokers. Calcif Tissue Int 55:403–407

    Article  PubMed  CAS  Google Scholar 

  27. Valimaki MJ, Karkkainen M, Lamberg-Allardt C, Laitinen K, Alhava E, Heikkinen J, Impivaara O, Makela P, Palmgren J, Seppanen R et al (1994) Exercise, smoking, and calcium intake during adolescence and early adulthood as determinants of peak bone mass. Cardiovascular Risk in Young Finns Study Group. BMJ 309:230–235

    Article  PubMed  CAS  Google Scholar 

  28. Benowitz NL, Lessov-Schlaggar CN, Swan GE, Jacob P 3rd (2006) Female sex and oral contraceptive use accelerate nicotine metabolism. Clin Pharmacol Ther 79:480–488

    Article  PubMed  CAS  Google Scholar 

  29. Gan WQ, Cohen SB, Man SF, Sin DD (2008) Sex-related differences in serum cotinine concentrations in daily cigarette smokers. Nicotine Tob Res 10:1293–1300

    Article  PubMed  CAS  Google Scholar 

  30. Benowitz NL (1988) Drug therapy. Pharmacologic aspects of cigarette smoking and nicotine addition. N Engl J Med 319:1318–1330

    Article  PubMed  CAS  Google Scholar 

  31. Benowitz NL (1999) Nicotine addiction. Prim Care 26:611–631

    Article  PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Department of Preventive Medicine, Center for Occupational and Environmental Medicine, College of Medicine, The Catholic University of Korea, 222 Banpo-Daero Seocho-gu, Seoul, 137-701, Republic of Korea

    J.-P. Myong, H.-R. Kim & J.-W. Koo

  2. Program in Nursing Science, College of Health Sciences, University of California, Irvine, CA, USA

    S. E. Choi

Authors
  1. J.-P. Myong
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  2. H.-R. Kim
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  3. S. E. Choi
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  4. J.-W. Koo
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Correspondence to H.-R. Kim.

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Myong, JP., Kim, HR., Choi, S.E. et al. Dose-related effect of urinary cotinine levels on bone mineral density among Korean females. Osteoporos Int 24, 1339–1346 (2013). https://doi.org/10.1007/s00198-012-2107-6

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  • DOI: https://doi.org/10.1007/s00198-012-2107-6

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