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Osteoporosis International

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01-01-2016 | Original Article

Smoking, smoking cessation, and fracture risk in elderly women followed for 10 years

Authors: M. H. Thorin, A. Wihlborg, K. Åkesson, P. Gerdhem

Published in: Osteoporosis International | Issue 1/2016

Abstract

Summary

This study examines the impact of smoking and smoking cessation on fracture risk in 75-year-old women followed for 10 years. Smoking increased fracture risk, especially for vertebral fractures. Smoking cessation decreased the risk for vertebral fractures but not for other fracture types.

Introduction

The purpose of this study was to examine effects of smoking and smoking cessation on fracture risk.

Methods

This prospective observational population-based study followed 1033 women during 10 years from age 75. Data regarding smoking were collected at age 75. Hazard ratios (HRs) and 95 % confidence intervals for fracture were calculated using competing risks proportional hazards regression.

Results

Both former smokers and current smokers had an increased risk for any fracture (HR 1.30; 1.03–1.66, and HR 1.32; 1.01–1.73, respectively) and any osteoporotic fracture (hip, proximal humerus, distal radius, vertebra) (HR 1.31; 1.01–1.70 and HR 1.49; 1.11–1.98, respectively) compared to non-smokers. Former smokers had an increased risk for proximal humerus fractures (HR 2.23; 1.35–3.70), and current smokers had an increased risk for vertebral fractures (HR 2.30; 1.57–3.38) compared to non-smokers. After adjustment for weight, previous fractures, alcohol habits, bone mineral density (BMD), use of corticoids, vitamin D, bisphosphonates, and previous falls, former smokers had an increased risk for proximal humerus fracture (HR 2.07; 1.19–3.57) and current smokers had an increased risk for osteoporotic (HR 1.47; 1.05–2.05) and vertebral fractures (HR 2.50; 1.58–3.95) compared to non-smokers. Former smokers had a decreased risk for vertebral fractures, but not for other types of fractures, compared to current smokers.

Conclusions

Smoking increased the risk for fracture among elderly women, especially vertebral fractures. Smoking cessation decreased the risk for vertebral fractures but not for other types of fractures.

Cummings SR, Melton LJ (2002) Epidemiology and outcomes of osteoporotic fractures. Lancet 359(9319):1761–1767. doi:10.1016/s0140-6736(02)08657-9 PubMedCrossRef

Hernlund E, Svedbom A, Ivergard M, Compston J, Cooper C, Stenmark J, McCloskey EV, Jonsson B, Kanis JA (2013) Osteoporosis in the European Union: medical management, epidemiology and economic burden. A report prepared in collaboration with the International Osteoporosis Foundation (IOF) and the European Federation of Pharmaceutical Industry Associations (EFPIA). Arch Osteoporos 8(1–2):136. doi:10.1007/s11657-013-0136-1 PubMedPubMedCentralCrossRef

Kanis JA, Oden A, McCloskey EV, Johansson H, Wahl DA, Cooper C (2012) A systematic review of hip fracture incidence and probability of fracture worldwide. Osteoporos Int 23(9):2239–2256. doi:10.1007/s00198-012-1964-3 PubMedPubMedCentralCrossRef

Kanis JA, Johnell O, Oden A, Sembo I, Redlund-Johnell I, Dawson A, De Laet C, Jonsson B (2000) Long-term risk of osteoporotic fracture in Malmo. Osteoporos Int 11(8):669–674PubMedCrossRef

Kanis JA (2002) Diagnosis of osteoporosis and assessment of fracture risk. Lancet 359(9321):1929–1936. doi:10.1016/s0140-6736(02)08761-5 PubMedCrossRef

Yoon V, Maalouf NM, Sakhaee K (2012) The effects of smoking on bone metabolism. Osteoporos Int 23(8):2081–2092. doi:10.1007/s00198-012-1940-y PubMedCrossRef

Kanis JA, Johnell O, Oden A, Johansson H, De Laet C, Eisman JA, Fujiwara S, Kroger H, McCloskey EV, Mellstrom D, Melton LJ, Pols H, Reeve J, Silman A, Tenenhouse A (2005) Smoking and fracture risk: a meta-analysis. Osteoporos Int 16(2):155–162. doi:10.1007/s00198-004-1640-3 PubMedCrossRef

Vestergaard P, Mosekilde L (2003) Fracture risk associated with smoking: a meta-analysis. J Intern Med 254(6):572–583PubMedCrossRef

Ng M, Freeman MK, Fleming TD, Robinson M, Dwyer-Lindgren L, Thomson B, Wollum A, Sanman E, Wulf S, Lopez AD, Murray CJ, Gakidou E (2014) Smoking prevalence and cigarette consumption in 187 countries, 1980–2012. JAMA 311(2):183–192. doi:10.1001/jama.2013.284692 PubMedCrossRef

10.

Centers for Disease Control and Prevention (2001) Women and smoking: a report of the surgeon general. Available at www.cdc.gov/tobacco/data_statistics/sgr/2001/index.htm. Accessed April 2015

11.

Gerdhem P, Obrant KJ (2002) Effects of cigarette-smoking on bone mass as assessed by dual-energy x-ray absorptiometry and ultrasound. Osteoporos Int 13(12):932–936. doi:10.1007/s001980200130 PubMedCrossRef

12.

Oncken C, Prestwood K, Cooney JL, Unson C, Fall P, Kulldorff M, Raisz LG (2002) Effects of smoking cessation or reduction on hormone profiles and bone turnover in postmenopausal women. Nicotine Tob Res 4(4):451–458. doi:10.1080/1462220021000018399 PubMedCrossRef

13.

Olofsson H, Byberg L, Mohsen R, Melhus H, Lithell H, Michaelsson K (2005) Smoking and the risk of fracture in older men. J Bone Miner Res 20(7):1208–1215. doi:10.1359/jbmr.050208 PubMedCrossRef

14.

Wihlborg A, Akesson K, Gerdhem P (2014) External validity of a population-based study on osteoporosis and fracture. Acta Orthop 85(4):433–437. doi:10.3109/17453674.2014.920987 PubMedPubMedCentralCrossRef

15.

Wihlborg A, Englund M, Akesson K, Gerdhem P (2015) Fracture predictive ability of physical performance tests and history of falls in elderly women: a 10-year prospective study. Osteoporos Int 26(8):2101–2109. doi:10.1007/s00198-015-3106-1 PubMedCrossRef

16.

Gerdhem P, Akesson K (2007) Rates of fracture in participants and non-participants in the Osteoporosis Prospective Risk Assessment study. J Bone Joint Surg (Br) 89(12):1627–1631. doi:10.1302/0301-620x.89b12.18946 CrossRef

17.

Lenora J, Akesson K, Gerdhem P (2010) Effect of precision on longitudinal follow-up of bone mineral density measurements in elderly women and men. J Clin Densitom 13(4):407–412. doi:10.1016/j.jocd.2010.04.004 PubMedCrossRef

18.

Tenne M, McGuigan F, Besjakov J, Gerdhem P, Akesson K (2013) Degenerative changes at the lumbar spine--implications for bone mineral density measurement in elderly women. Osteoporos Int 24(4):1419–1428. doi:10.1007/s00198-012-2048-0 PubMedCrossRef

19.

Jónsson B (1993) Life style and fracture risk. University of Lund, Lund

20.

Fine JP, Gray RJ (1999) A proportional hazards model for the subdistribution of a competing risk. J Am Stat Assoc 94(446):496–509. doi:10.2307/2670170 CrossRef

21.

Forsen L, Bjorndal A, Bjartveit K, Edna TH, Holmen J, Jessen V, Westberg G (1994) Interaction between current smoking, leanness, and physical inactivity in the prediction of hip fracture. J Bone Miner Res 9(11):1671–1678. doi:10.1002/jbmr.5650091102 PubMedCrossRef

22.

la Vecchia C, Negri E, Levi F, Baron JA (1991) Cigarette smoking, body mass and other risk factors for fractures of the hip in women. Int J Epidemiol 20(3):671–677PubMedCrossRef

23.

Cumming RG, Klineberg RJ (1994) Case–control study of risk factors for hip fractures in the elderly. Am J Epidemiol 139(5):493–503PubMed

24.

Cornuz J, Feskanich D, Willett WC, Colditz GA (1999) Smoking, smoking cessation, and risk of hip fracture in women. Am J Med 106(3):311–314PubMedCrossRef

25.

Hemenway D, Colditz GA, Willett WC, Stampfer MJ, Speizer FE (1988) Fractures and lifestyle: effect of cigarette smoking, alcohol intake, and relative weight on the risk of hip and forearm fractures in middle-aged women. Am J Public Health 78(12):1554–1558PubMedPubMedCentralCrossRef

26.

Cummings SR, Nevitt MC, Browner WS, Stone K, Fox KM, Ensrud KE, Cauley J, Black D, Vogt TM (1995) Risk factors for hip fracture in white women. Study of Osteoporotic Fractures Research Group. N Engl J Med 332(12):767–773. doi:10.1056/nejm199503233321202 PubMedCrossRef

27.

Meyer HE, Tverdal A, Falch JA (1993) Risk factors for hip fracture in middle-aged Norwegian women and men. Am J Epidemiol 137(11):1203–1211PubMed

28.

Baron JA, Farahmand BY, Weiderpass E, Michaelsson K, Alberts A, Persson I, Ljunghall S (2001) Cigarette smoking, alcohol consumption, and risk of hip fracture in women. Arch Intern Med 161(7):983–988PubMedCrossRef

29.

Jarvinen TL, Sievanen H, Khan KM, Heinonen A, Kannus P (2008) Shifting the focus in fracture prevention from osteoporosis to falls. BMJ 336(7636):124–126. doi:10.1136/bmj.39428.470752.AD PubMedPubMedCentralCrossRef

30.

Kelsey JL, Samelson EJ (2009) Variation in risk factors for fractures at different sites. Curr Osteoporos Rep 7(4):127–133PubMedPubMedCentralCrossRef

31.

O’Neill TW, Marsden D, Adams JE, Silman AJ (1996) Risk factors, falls, and fracture of the distal forearm in Manchester, UK. J Epidemiol Community Health 50(3):288–292PubMedPubMedCentralCrossRef

32.

Hemenway D, Azrael DR, Rimm EB, Feskanich D, Willett WC (1994) Risk factors for wrist fracture: effect of age, cigarettes, alcohol, body height, relative weight, and handedness on the risk for distal forearm fractures in men. Am J Epidemiol 140(4):361–367PubMed

33.

Kelsey JL, Browner WS, Seeley DG, Nevitt MC, Cummings SR (1992) Risk factors for fractures of the distal forearm and proximal humerus. The Study of Osteoporotic Fractures Research Group. Am J Epidemiol 135(5):477–489PubMed

34.

Hagino H, Fujiwara S, Nakashima E, Nanjo Y, Teshima R (2004) Case–control study of risk factors for fractures of the distal radius and proximal humerus among the Japanese population. Osteoporos Int 15(3):226–230. doi:10.1007/s00198-003-1543-8 PubMedCrossRef

35.

Clarke B (2008) Normal bone anatomy and physiology. Clin J Am Soc Nephrol 3(Suppl 3):S131–S139. doi:10.2215/cjn.04151206 PubMedPubMedCentralCrossRef

36.

Lappin DF, Sherrabeh S, Jenkins WM, Macpherson LM (2007) Effect of smoking on serum RANKL and OPG in sex, age and clinically matched supportive-therapy periodontitis patients. J Clin Periodontol 34(4):271–277. doi:10.1111/j.1600-051X.2007.01048.x PubMedCrossRef

37.

Hoidrup S, Prescott E, Sorensen TI, Gottschau A, Lauritzen JB, Schroll M, Gronbaek M (2000) Tobacco smoking and risk of hip fracture in men and women. Int J Epidemiol 29(2):253–259PubMedCrossRef

38.

Ward KD, Klesges RC (2001) A meta-analysis of the effects of cigarette smoking on bone mineral density. Calcif Tissue Int 68(5):259–270PubMedCrossRef

39.

Pickett KE, Kasza K, Biesecker G, Wright RJ, Wakschlag LS (2009) Women who remember, women who do not: a methodological study of maternal recall of smoking in pregnancy. Nicotine Tob Res 11(10):1166–1174. doi:10.1093/ntr/ntp117 PubMedPubMedCentralCrossRef

40.

Krall EA, Valadian I, Dwyer JT, Gardner J (1989) Accuracy of recalled smoking data. Am J Public Health 79(2):200–202PubMedPubMedCentralCrossRef

Title: Smoking, smoking cessation, and fracture risk in elderly women followed for 10 years
Authors: M. H. Thorin
A. Wihlborg
K. Åkesson
P. Gerdhem
Publication date: 01-01-2016
Publisher: Springer London
Published in: Osteoporosis International / Issue 1/2016
Print ISSN: 0937-941X
Electronic ISSN: 1433-2965
DOI: https://doi.org/10.1007/s00198-015-3290-z

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Smoking, smoking cessation, and fracture risk in elderly women followed for 10 years

Abstract

Summary

Introduction

Methods

Results

Conclusions

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Summary

Introduction

Methods

Results

Conclusions

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