Smoking and What it Does to Your Bones

By Charles Pesson, MD

It has been documented for years that smoking is bad for your general health. It causes a marked increase in the risk of lung disease, including cancer, and COPD (Chronic Obstructive Pulminary Disorders). In addition to lung disease, there is also an increased risk of heart disease and hardening of the arteries, also known as peripheral vascular disease. In fact, smoking is the leading avoidable cause of morbidity (sickness) and mortality (death) in the United States. Records show that 500,000 deaths annually are directly attributed to smoking in the US, and millions more worldwide.

So maybe you know the damage smoking causes the heart and lungs, but do you know what smoking does to your bones?

Research shows that smoking has negative effects on your entire skeletal system. Medical studies have documented a long list of the harmful effects that smoking has on the musculoskeletal system including decreased bone density (also known as osteoporosis), a high risk of lumbar disk problems, lower back pain, disabling leg cramps, higher risk of sustaining hip and wrist fractures, and high risk of failure of bone fusion in fractures and grafts. This is evidenced in one recent study which showed that 50% of smokers suffered from low back pain compared with only 20% of non-smokers.

Smoking also has an adverse affect on wound healing after surgery. On top of that, there’s evidence of an increased risk of postoperative infection as well. The list of negative effects like these goes on and on. That’s why current data clearly shows that a smoker should consider stopping smoking before and after surgery.

But how does smoking actually cause all these harmful side effects? Well, wound healing, for example, is compromised by the nicotine in cigarettes, which causes a decreased blood flow in the local tissue. The nicotine constricts the blood vessels that deliver oxygen to the tissue to just 25% of their normal diameter. An adequate amount of oxygen is vital in the formation of mature collagen, which serves as the glue that helps close a wound. So when nicotine is in your body, chances are you’re not getting all the necessary oxygen so wounds struggle to close. Oxygen is also critical in bone healing, so when those oxygen-delivering blood vessels are constricted, nutrients that are needed for bone healing are significantly diminished. This is yet another reason why it takes more time for fractures to heal in smokers than non-smokers. In fact, one study, looking at a specific wrist fracture in 54 patients, showed 95% of the non-smokers healed compared with only 68% of the smokers. The average time of healing was 2 months longer in the smokers!

With evidence like this, I’m sure you’re beginning to see why it is extremely important that smoking is stopped as soon as an individual sustains any type of fracture. Continued smoking will result in a decreased likelihood of complete recovery, lengthened time spent healing, and generally an increased chance of an unsatisfactory outcome.

So what are you waiting for? Why not stop? Well, it’s easier said than done. There are chemicals in cigarettes, namely nicotine, that are extremely addictive so it can be quite difficult to stop smoking without the assistance of a healthcare professional. However, there are medications available that help curb the urge to smoke while the body goes through the necessary withdraws from the effects of nicotine. So why risk it? It’s never too late, many of the harmful side effects of smoking are reversible. So seek the help of your health care provider and fight your addiction. Work towards a having a healthy musculoskeletal system! Your bones will thank you.