Higher incidence of osteoporosis and fractures found among male smokers

by Bruce Sylvester: Results of a retrospective study suggest that, among middle-aged to elderly smokers, men have a higher risk than women of developing osteoporosis and fractures of their vertebrae.

Both history of smoking and chronic obstructive pulmonary disease (COPD) emerged in the study as independent risk factors for low bone density among both sexes.

The findings appeared online on March 6, 2015 in the Annals of the American Thoracic Society.

“Our findings suggest that current and past smokers of both genders should be screened for osteoporosis,” said Elizabeth Regan, MD, assistant professor of medicine at National Jewish Health in Denver, Colorado. “Expanding screening to include men with a smoking history and starting treatment in those with bone disease may prevent fractures, improve quality of life and reduce health care costs.”

The investigators evaluated data on 3,321 current and ex-smokers, male and female, ages 45 to 80, with a minimum of 10 pack-years of smoking history.

They used findings from quantitative CT scans to assess bone density.

They reported that 11 percent of the subjects had normal bone density, 31 percent had intermediate bone density, and 58 percent had low bone density.

Thirty-seven percent of all subjects had suffered one or more fractures of the vertebrae. Notably, men accounted for 55 percent of the subjects with low bone density and 60 percent of the subjects with vertebral fractures.

The researchers also noted that low-bone density increased among subjects with worsening COPD, rising to 84 percent among severe COPD patients of both sexes.

Each additional pack-year of smoking raised the odds of developing low bone density by 0.4 percent. Subjects with normal bone density had an average of 36.6 pack-year of smoking history, and subjects with low bone density had an average of 46.9 pack-years of smoking history.

Even though smoking has been recognized as a risk factor for osteoporosis, neither smoking history nor COPD are among currently suggested criteria in the US for bone-density screening.

“The growing use of CT scans to screen heavy smokers for lung cancer may provide an opportunity to use the same scans for bone density screening in this high-risk population,” added Regan.