Endocrine Effects of Tobacco Smoking

Konstantinos Tziomalos; Faidon Charsoulis


Clin Endocrinol. 2004;61(6) 

In This Article


There is growing evidence that cigarette smoking has a negative impact on bone mass. The skeletal effects of smoking seem to be more pronounced in men (Seeman & Melton, 1983; Jensen & Christiansen, 1988; Krall & Dawson-Hughes, 1991; Slemenda et al., 1992; Egger et al., 1996; Kiel et al., 1996; Hannan et al., 2000; Izumotani et al., 2003; Bakhireva et al., 2004), but similar effects have also been found in postmenopausal women (Daniell, 1976; Jones et al., 1994; Nguyen et al., 1994; Hannan et al., 2000; Gerdhem & Obrant, 2002; MacInnis et al., 2003). Nevertheless, smoking is not associated with lower premenopausal bone mineral density (Law & Hackshaw, 1997; Bainbridge et al., 2004). This discrepancy between pre- and postmenopausal women may be explained by a greater cumulative tobacco exposure in older smokers or a greater sensitivity to smoking-induced bone loss after the menopause and/or with ageing (MacInnis et al., 2003). There is also an increased fracture risk in smokers; this effect is strongest in women, with a twofold risk of fracture for current smokers compared with current nonsmokers (Burns et al., 2003). It should be noted that no bone mass differences were found between former and never-smokers (Gerdhem & Obrant, 2002).

Part of this detrimental effect of smoking on bone metabolism is mediated by an adverse influence on sex-steroid metabolism, and in particular by an oestrogen-lowering effect (Michnovicz et al., 1986; Ortego-Centeno et al., 1994; Tanko & Christiansen, 2004). Direct toxic effects on bone may also be an influence, to some extent (Orwell & Klein, 1995). Furthermore, serum 25-hydroxyvitamin D levels are lower in smokers than in nonsmokers (Valimaki et al., 2003). Smoking also seems to dampen the bone protective effects of nutritional calcium in postmenopausal women (Sirola et al., 2003). Finally, at least part of the negative influence of smoking in bone mass is explained by weight and physical activity differences between smokers and nonsmokers (Jensen, 1986; Ooms et al., 1993; Nguyen et al., 1994).