“Giving up smoking is the easiest thing in the world. I know because I’ve done it thousands of times.” ~ Mark Twain

Probably the last thing smokers are thinking about at any given moment is their bones. They may consider their lungs, their skin, the yellow fingernails, the smell of smoke that permeates every layer of clothing – but they rarely remember their bones.

And yet new studies show that the effect on the bones of smoking is nothing short of catastrophic, reducing them from strong and dense to a latticework of potential collapse. Smoking allows osteoporosis to move in like a virulent weed into a rickety old house. Silently, pervasively and certainly.

The direct relationship between smoking and decreased bone density has been conclusively proven. But before you protest this statement, while nervously puffing away to calm your nerves, just consider this: “Because the evidence linking smoking with increased fracture risk is so strong, smoking is one of the scientifically validated risk factors which is included in FRAX® (WHO Fracture Risk Assessment Tool), the online tool which calculates an individual’s 10-year risk of osteoporotic fracture.”

Let’s see why smoking has climbed the blacklist in recent years

  • Smoking reduces the blood supply to the bones and to many other body tissues.
  • The nicotine in cigarettes slows production of bone-producing cells, called osteoblasts.
  • The nicotine in cigarettes decreases the body’s ability to absorb calcium, which is necessary for vital cellular functions and bone health.
  • Smoking affects the balance of hormones, including estrogen in women and testosterone in men, which is needed to build and maintain a strong skeleton. Nicotine, along with other toxic substances in cigarettes, can trigger bone-damaging changes by breaking down estrogen more quickly. And because estrogen is import to building and maintaining a strong skeleton, the last thing you want is something that breaks it down.
  • Evidence shows that the longer you smoke and the more cigarettes you consume, the greater your risk of fracture in old age.
  • Smokers who experience a fracture tend to take longer to heal than non-smokers, and they may experience more complications during the healing process.
  • Exposure to second-hand smoke during youth and early adulthood may increase the risk of developing low bone mass. (As early as that. Take note!)
  • Compared with non-smokers, women who smoke may produce less estrogen and experience menopause earlier, which in turn may lead to increased bone loss.
  • Studies have shown that roughly one in eight hip fractures may result from cigarette smoking. It indisputable that smokers lose bone at faster rates than non-smokers, and by age 80, this can translate into 6% lower bone mineral density, and therefore much greater risk of fractures.

Collateral damage

The weight game: People who smoke tend to be thinner than non-smokers. They may also be less physically active and have poor diets.

Weakened collagen: Nicotine is toxic for the body. One effect of this toxicity is that it breaks down the collagen in the skin and body’s connective tissues (including muscles, bones, blood vessels, the digestive system, and tendons) faster than would occur during normal ageing.

Slower healing process: When your collagen is weaker, it’s more difficult for the body to regenerate tissues. This leads to delayed healing time for wounds, fractures, and tendon damage. This is particularly risky when recovering from surgery.

Cardiovascular issues: Smoking decreases the supply of blood and oxygen to the body, which causes damage to your blood vessels, putting a greater strain on your cardiovascular system. This also puts a strain on the body when exercising.

Loss of muscle mass and strength: Smoking makes it difficult for your muscles to metabolise the energy produced during physical exercise, which in turn delays your body’s recovery time and ability to regenerate. When the body can’t repair itself as readily as it should, muscle inflammation increases, and you’re more likely to be fatigued and plagued by muscle pain.

It’s hard for smokers to come to terms with the damage this habit does to the body. Many think, that because they’re well and active of the moment, things will stay that way. Smoking is one of the most insidious poisons because it takes years to reflect its toll, up to ten years. And then, the reversal of that damage can take just as long. There is no glamour to smoking, no sophistication; it’s a little tube of costly ill health, low self-esteem, and weak resolve. It’s vital to prove yourself stronger than the habit – and feel that strength resurge throughout the mind and body.

Take a deep breath – of sweet, fresh air! And love your bones.

NOFSA (National Osteoporosis Foundation South Africa)

NOFSA is the only non-profit, voluntary health organisation dedicated to promoting lifelong bone health. We focus on reducing the widespread prevalence of osteoporosis while working to find a cure for the disease, and by supporting research and developing programmes of education and advocacy.

Find out more about our work at: www.osteoporosis.org.za