Smoking and Your Bones

Patient Education Materials

How Smoking Affects Your Bones


If you are a smoker, then your smoking and your bones are working against one another. When you smoke, you put yourself at risk for a condition that causes loss of bone mass. The name of the condition is osteoporosis (OSS-tee-oh-por-OH-sis). When bones lose mass, they weaken, and weak bones can easily break (fracture).

What makes bones strong?

Bone is a living organ made from several substances. Collagen (CALL-uh-jen) forms the framework of the bone. The mineral calcium is deposited into this framework. For bones to grow strong and stay strong, they need calcium.

Inside our bones, a constant process of renewal goes on. Some cells in the bone are called osteoclasts (OSS-tee-oh-klasts). Their job is to break down old bone. Just as fast, other cells use calcium to build up new bone. These cells are called osteoblasts (OSS-tee-oh blasts). This process of renewal helps to keep our bones healthy and strong.

What is bone mass?

When we are young and get enough calcium, our bones are dense — they are packed full of mineral. This is called bone mass. Our bone mass increases until we’re age 25 to 30. At this time, we reach our “peak” bone mass.

What is loss of bone mass?

After age 30, the renewal process in our bones slows down. Bone breaks down faster than it can be replaced. Our bone mass starts to decrease slowly, whether we’re male or female. Bones start to thin as the bone mineral becomes less dense. We call this loss of bone mass osteoporosis. Other factors besides aging can also decrease bone mass.

smoking-and-your-bonesHow does smoking affect my bones?

Smoking reduces the amount of calcium your bones absorb. Vitamin D helps bones to absorb calcium, but smoking interferes with how your body uses vitamin D. Less calcium is then available to build strong bones. As a result, your bones start to get brittle.

Smoking lowers estrogen levels in both men and women. Estrogen is important because it helps the bones to hold calcium and other minerals that make them strong. At menopause, a woman’s body makes much less estrogen, and this puts her naturally at risk for osteoporosis. Smoking increases her risk even more.

To hold calcium, the bones also need help from weight-bearing exercise, such as walking. Smokers, however, tend to get less exercise than non-smokers do. Smoking is also toxic to osteoblasts (bone-forming cells).

How does smoking increase the risk of osteoporosis?

Smoking during your bone-building years makes your bone mass peak at a lower level. This puts you at risk for osteoporosis in later years. Smoking after age 30 speeds up your loss of bone mass — it occurs 1.5 to 2 times faster. Your whole body loses bone mass, but the hip, spine, and wrist are the most affected. The more you smoke, the greater your risk for osteoporosis.

Do both male and female smokers increase their risk for osteoporosis?
Yes. Osteoporosis risk is 2.5 times greater for male and female smokers than for non-smokers. Both male and female smokers have lower bone mineral density than non-smokers of the same age and sex. The bone mineral content of female smokers is 15 to 30 percent less than that of non-smokers. The bone mineral content of male smokers is 10 to 20 percent less than that of non-smokers.

Are any bones more at risk for a fracture among smokers?

Yes. The hips and spine are especially at risk for a fracture when you smoke. Smokers have 2 to 4 times more risk than non-smokers of a hip fracture linked to osteoporosis. Smokers also have greater risk for fractures of the spine.

Can I smoke and use medicine to prevent osteoporosis? 

If you take estrogen to increase your bone density to prevent osteoporosis, smoking will reduce the drug’s ability to work.

Does second-hand smoke have any effect on my bones? 

Breathing second-hand smoke affects your bones the same way that smoking does.

If I quit smoking, will it help my bones?

You eliminate one of the causes of osteoporosis when you quit smoking.