The DOI matches its Crossref record; 134 of the 134 references it cites were found in a registry or an index.
The effects of smoking on bone metabolism
Abstract
Osteoporosis is a common, morbid and costly disorder characterized by deterioration in bone strength. Cigarette smoking is associated with reduced bone mineral density (BMD) and increased fracture risk. There are basic, clinical, and observational studies that define several of the underlying pathophysiologic mechanisms that predispose smokers to bone loss. Such mechanisms include alterations in calciotropic hormone metabolism and intestinal calcium absorption, dysregulation in sex hormone production and metabolism, alterations in adrenal cortical hormone metabolism and in the receptor activator of nuclear factor kappa-B (RANK), receptor activator of nuclear factor kappa-B ligand (RANKL), and osteoprotegerin (OPG) system (RANK-RANKL-OPG system), and direct cellular effects of cigarette use on bone cells. In addition, there is evidence of reversibility in the aforementioned mechanisms with smoking cessation. In summary, cigarette smoking is a reversible risk factor for osteoporosis and osteoporotic fractures through diverse pathophysiologic mechanisms.
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“Similar to women, the mechanism of aromatase inhibition was reported in men; this mechanism suppressed production of estradiol from testosterone [16].”
From The Effect of Tobacco Smoking on Bone Mass: An Overview of Pathophysiologic Mechanisms (2018) · cites this paper as [16]
In the citing paper
“which may be related to the decreased intake of vitamin D or the induction of the liver enzyme that enhances hepatic metabolism of vitamin D metabolites [5], or via suppression of parathyroid hormone (PTH) release [16].”
From The Effect of Tobacco Smoking on Bone Mass: An Overview of Pathophysiologic Mechanisms (2018) · cites this paper as [16]
In the citing paper
“Bone is dynamic tissue undergoing continuous remodeling via bone formation and resorption [16, 68].”
From The Effect of Tobacco Smoking on Bone Mass: An Overview of Pathophysiologic Mechanisms (2018) · cites this paper as [16]
In the citing paper
“The activities of both are regulated by several factors, including the RANKL-RANK-OPG pathway, estradiol, various cytokines, and calciotropic hormones [16, 45, 69].”
From The Effect of Tobacco Smoking on Bone Mass: An Overview of Pathophysiologic Mechanisms (2018) · cites this paper as [16]
In the citing paper
“Nicotine has an inhibitory effect on osteogenesis and on angiogenesis that play key roles in bone metabolism [16].”
From The Effect of Tobacco Smoking on Bone Mass: An Overview of Pathophysiologic Mechanisms (2018) · cites this paper as [16]
In the citing paper
“After bone reaches peak mass, it undergoes constant remodeling via resorption followed by formation [16, 68].”
From The Effect of Tobacco Smoking on Bone Mass: An Overview of Pathophysiologic Mechanisms (2018) · cites this paper as [16]
In the citing paper
“Laboratory studies found rats exposed to smoke inhalation had higher levels of RANKL/OPG ratio compared to control rats not exposed to smoke [16, 90].”
From The Effect of Tobacco Smoking on Bone Mass: An Overview of Pathophysiologic Mechanisms (2018) · cites this paper as [16]
In the citing paper
“Several studies have indicated that smoking downregulates vitamin D serum levels [42,43] and inhibits the production of PTH [44].”
From An Overlooked Bone Metabolic Disorder: Cigarette Smoking-Induced Osteoporosis (2022) · cites this paper as [44]
In the citing paper
“Cigarette smoking is also considered one of the main social risk factors for developing metabolic bone diseases (such as osteoporosis, Paget’s disease, osteomalacia, and diabetic osteopathy), which compromise bone remodeling for a variety of reasons, including altered bone formation by osteoblasts, increased bone degradation by osteoclasts, or a combination of both [12,14,15].”
From Skeletal System Biology and Smoke Damage: From Basic Science to Medical Clinic (2021) · cites this paper as [14]
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“Although smoking has been known to be a major risk factor in many studies [11,22], it was not a statistically significance factor in our study, which was probably due to the fact that the majority of patients enrolled in our study were postmenopausal women with a smoking rate of only 6.”
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“The alterations may occur as direct or indirect effects of CS constituents on osteoblastic bone formation, and/or osteoclastic bone resorption, resulting in an imbalance between osteoblasts and osteoclasts [12].”
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“Additionally, some systematic effects of cigarette smoking, such as chronic inflammation, vascular damage, and increased oxidative stress, may negatively affect bone mineral content [29,30].”
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The Impact of Obesity and Smoking on Outcomes After Volar Plate Fixation of Distal Radius Fractures
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Otero, C. E., Noeker, J. A., Brown, M. M., Wavreil, F. D. M., Harvey, W. A., Mitchell, K. A., & Heggland, S. J. (2019) · Journal of Applied Toxicology · doi:10.1002/jat.3777 · Cited by 34
“First, tobacco smoke exposure can indirectly alter bone function by increasing parathyroid hormone release, increasing cortisol production or reducing vitamin D metabolism (Abate, Vanni, Pantalone, & Salini, 2013; Yoon et al., 2012).”
The deleterious effects of smoking in bone mineralization and fibrillar matrix composition
Barbosa, A. P., Lourenço, J. D., Junqueira, J. J. M., de França, S. L. E., Martins, J. D. S., Oliveira‐Junior, M. C., Begalli, I., Velosa, A. P. P., Olivo, C. R., Bastos, T. B., et al. (2019) · Life Sciences · doi:10.1016/j.lfs.2019.117132 · Cited by 33
Pompe, E., Bartstra, J. W., Verhaar, H. J. J., de Koning, H. J., van der Aalst, C. M., Oudkerk, M., Vliegenthart, R., Lammers, J. J., de Jong, P. A., & Hoesein, F. A. A. M. (2017) · European Journal of Radiology · doi:10.1016/j.ejrad.2017.02.011 · Cited by 32
Impact of Cigarette Smoking on the Risk of Osteoporosis in Inflammatory Bowel Diseases
Ratajczak, A. E., Szymczak‐Tomczak, A., Rychter, A. M., Zawada, A. E., Dobrowolska, A., & Krela‐Kaźmierczak, I. (2021) · Journal of Clinical Medicine · doi:10.3390/jcm10071515 · Cited by 37
“Additionally, nicotine disturbs the hydroxylation of vitamin D, affecting OPG and RANK [30].”
BackgroundSasaki, M., Chubachi, S., Kameyama, N., Sato, M., Haraguchi, M., Miyazaki, M., Takahashi, S., Nakano, T., Kuroda, Y., Betsuyaku, T., et al. (2018) · PLoS ONE · doi:10.1371/journal.pone.0191611 · Cited by 32
Reumann, M. K., Schaefer, J. P., Titz, B., Aspera-Werz, R. H., Wong, E. T., Szostak, J., Häussling, V., Ehnert, S., Leroy, P., Tan, W. T., et al. (2020) · Archives of Toxicology · doi:10.1007/s00204-020-02769-4 · Cited by 30
Bone Fragility in Gastrointestinal Disorders
Merlotti, D., Mingiano, C., Valenti, R., Cavati, G., Calabrese, M., Pirrotta, F., Bianciardi, S., Palazzuoli, A., & Gennari, L. (2022) · International Journal of Molecular Sciences · doi:10.3390/ijms23052713 · Cited by 30
“Additionally, smokers have a lower OPG level and higher RANKL/OPG ratio when compared with non-smokers [32], while nicotine disturbs the hydroxylation of vitamin D [33].”
BackgroundWang, Y., Sun, L., Dong, Z., Zhang, T., Wang, L., Cao, Y., Xu, H., Liu, C., & Chen, B. (2025) · Materials Today Bio · doi:10.1016/j.mtbio.2025.101501 · Cited by 29
“Additionally, once tobacco-derived toxins reach the skeletal system via the bloodstream, they trigger inflammation, impair bone nutrition, and disrupt bone metabolism [5 – 7].”
Pezzuto, A., Perrone, G., Orlando, N., Citarella, F., Ciccozzi, M., Scarlata, S., & Tonini, G. (2019) · Oncotarget · doi:10.18632/oncotarget.27378 · Cited by 27
“It also favors bone metastases through the activation of several growth factors, transcriptional factors, oncogene activation and inhibition of apoptosis [10, 11].”
BackgroundInterleukin-17A Deficiency Attenuated Emphysema and Bone Loss in Mice Exposed to Cigarette Smoke
Xiong, J., Tian, J., Zhou, L., Le, Y., & Sun, Y. (2020) · International Journal of COPD · doi:10.2147/copd.s235384 · Cited by 26
Idiopathic Osteoporosis and Nephrolithiasis: Two Sides of the Same Coin?
Rendina, D., FILIPPO, G. D., Iannuzzo, G., Abate, V., Strazzullo, P., & Falchetti, A. (2020) · International Journal of Molecular Sciences · doi:10.3390/ijms21218183 · Cited by 27
“Nicotine also has an inhibitory effect on osteogenesis [105,106].”
BackgroundAlexandrou, A. P., Tsoka, E., Armeni, E., Rizos, D., Diamantis, T., Augoulea, A., Panoulis, C., Liakakos, T., & Lambrinoudaki, I. V. (2015) · International Journal of Endocrinology · doi:10.1155/2015/984935 · Cited by 26
“Representing a known risk factor of bone loss, smoking may interact with 25 hydroxylase in the liver, resulting in lower levels of 25(OH) vitamin D [28].”
BackgroundSmoking and other determinants of bone turnover
Jorde, R., Stunes, A. K., Kubiak, J., Grimnes, G., Thorsby, P. M., & Syversen, U. (2019) · PLOS ONE · doi:10.1371/journal.pone.0225539 · Cited by 25
“Smokers also had significantly lower creatinine than non-smokers, a difference that also was significant (P 0.001) after adjusting for sex, age and BMI.”
BackgroundInfluentialSuman, B., Vijayalakshmi, K. R., & Kumar, S. (2021) · Journal of Dental Research Dental Clinics Dental Prospects · doi:10.34172/joddd.2021.024 · Cited by 27
Albrecht, B. M., Stalling, I., Foettinger, L., Recke, C., & Bammann, K. (2022) · Nutrients · doi:10.3390/nu14122463 · Cited by 25
“Smoking has similar effects on the skeletal system and should be ceased [20].”
BackgroundImpact of Chronic Inflammation in Psoriasis on Bone Metabolism
Saalbach, A., & Kunz, M. (2022) · Frontiers in Immunology · doi:10.3389/fimmu.2022.925503 · Cited by 25
Nagata, J. M., Carlson, J. L., Golden, N. H., Murray, S. B., Long, J., Leonard, M. B., & Peebles, R. (2018) · Eating and Weight Disorders - Studies on Anorexia Bulimia and Obesity · doi:10.1007/s40519-018-0521-2 · Cited by 25
“The semi-structured interview also included questions about menstrual status, self-reported tobacco use in the past month [23] and current use of antidepressants such as serotonin selective receptor uptake inhibitors (SSRI) [24] or tricyclic antidepressants (TCA) [25].”
Di, D., Zhou, H., Cui, Z., Zhang, J., Liu, Q., Yuan, T., Zhou, T., Luo, X., Ling, D., & Wang, Q. (2024) · Journal of Advanced Research · doi:10.1016/j.jare.2024.02.021 · Cited by 26
Marques, E. A., Elbejjani, M., Gudnason, V. G., Sigurdsson, G. T., Lang, T., Sigurdsson, S. O., Aspelund, T., Siggeirsdóttir, K., Launer, L. J., Eiríksdóttir, G., et al. (2018) · Bone · doi:10.1016/j.bone.2018.01.014 · Cited by 24
“(11) Several potential mechanisms have been proposed to explain the relationship between smoking and poorer bone health; these include mechanisms that represent more direct effects of smoking on bone cells, and other mechanisms influenced by factors such as body weight, physical activity, calcitropic processes, and se…”
BackgroundCeolin, C., Scala, A., Dall’Agnol, M., Ziliotto, C., Delbarba, A., Facondo, P., Citron, A., Vescovi, B., Pasqualini, S., Giannini, S., et al. (2023) · Journal of Endocrinological Investigation · doi:10.1007/s40618-023-02156-7 · Cited by 23
“Gender dysphoria (GD) is defined as a condition of psychological distress associated with gender incongruence [3].”
BackgroundResultInfluentialCigarette Smoke Exposure Inhibits Osteoclast Apoptosis via the mtROS Pathway
Qin, Y., Liu, Y., Jiang, Y., Mei, S., Liu, Y., Feng, J., Guo, L., Du, J., Graves, D. T., & Liu, Y. (2021) · Journal of Dental Research · doi:10.1177/00220345211009471 · Cited by 21
“Alterations in bone remodeling occur when nicotine or other constituents of cigarette smoke have indirect or direct effects on osteoblastic bone formation and osteoclast-mediated bone resorption (Ren et al. 2005; Yoon et al. 2012).”
BackgroundVitamin D Status of Residents in Taiyuan, China and Influencing Factors
Yan, X., Thomson, J. S., Zhao, R., Zhu, R., Wang, Z., Zhang, N., & Coad, J. (2017) · Nutrients · doi:10.3390/nu9080898 · Cited by 22
“Other studies have also found smoking to have a significant negative association with serum 25(OH)D [21,44].”
BackgroundCallréus, M., McGuigan, F. E., & Åkesson, K. (2013) · Calcified Tissue International · doi:10.1007/s00223-013-9785-8 · Cited by 21
“Meta-analyses have suggested that smoking-induced bone loss may be partially reversed by cessation of smoking [2, 31].”
Sridhar, D. C., Sidonio, R. F., & Ahuja, S. P. (2022) · Haemophilia · doi:10.1111/hae.14565 · Cited by 21
Bone health in patients with inflammatory bowel disease
Kreienbühl, A., Rogler, G., Burri, E., Biedermann, L., Meier, C., Juillerat, P., Restellini, S., Hruz, P. L., Vavricka, S. R., Aeberli, D., et al. (2024) · Swiss Medical Weekly · doi:10.57187/s.3407 · Cited by 22
“Therefore, patients should make every effort to stop smoking immediately [26, 55, 56].”
BackgroundChanges and tracking of bone mineral density in late adolescence: the Tromsø Study, Fit Futures
Nilsen, O. A., Ahmed, L. A., Winther, A., Christoffersen, T., Furberg, A., Grimnes, G., Dennison, E. M., & Emaus, N. (2017) · Archives of Osteoporosis · doi:10.1007/s11657-017-0328-1 · Cited by 20
Relationship between Bone Density, Eating Habit, and Nutritional Intake in College Students
Lim, H.-S., Ji, S., Hwang, H., Kang, J., Park, Y., Lee, H.-H., & Kim, T.-H. (2018) · Journal of Bone Metabolism · doi:10.11005/jbm.2018.25.3.181 · Cited by 18
“Nicotine in tobacco has been shown to decrease estrogen secretion, which inhibits calcium dissolution in bone, and to accelerate the conversion of estradiol to lower metabolites, thus affecting calcium and vitamin D metabolism.[22] According to Kim et al.”
BackgroundTomlinson, R. E., Schmieder, A. H., Quirk, J. D., Lanza, G. M., & Silva, M. J. (2014) · Journal of Bone and Mineral Research · doi:10.1002/jbmr.2223 · Cited by 20
“In addition, pathologies associated with decreased skeletal vascularization, such as osteoporosis,((43,44)) diabetes,((45,46)) and smoking,((47)) may be affected in the same way.”
BackgroundMa, M., Luo, S., Zhou, W., Lu, L., Cai, J., Yuan, F., & Yin, F. (2017) · Taiwanese Journal of Obstetrics and Gynecology · doi:10.1016/j.tjog.2016.04.038 · Cited by 19
The positive impact of smoking cessation on fracture risk in a nationwide cohort study
Park, J.-S., Kang, K., Park, S., Kim, J.-K., Han, K., & Hong, J. (2024) · Scientific Reports · doi:10.1038/s41598-024-60301-5 · Cited by 19
“In addition, smoking is associated with BMD 4–6 .”
BackgroundKwan, M. L., Lo, J. C.-M., Laurent, C. A., Roh, J. M., Tang, L., Ambrosone, C. B., Kushi, L. H., Quesenberry, C. P., & Yao, S. (2021) · Journal of Cancer Survivorship · doi:10.1007/s11764-021-00993-0 · Cited by 18
Bone Disease in HIV: Need for Early Diagnosis and Prevention
Schinas, G., Schinas, I., Ntampanlis, G., Polyzou, E., Gogos, C. A., & Akinosoglou, K. (2024) · Life · doi:10.3390/life14040522 · Cited by 17
“Lifestyle factors such as smoking and alcohol use are well-documented contributors to bone loss and fracture risk in the general population [56,57] and can have similar impacts on individuals with HIV.”
BackgroundCholinergic control of bone development and beyond
Janine, S., Frieß, J. L., Sperling, L. E., Thangaraj, G., Vogel‐Höpker, A., & Layer, P. G. (2020) · International Immunopharmacology · doi:10.1016/j.intimp.2020.106405 · Cited by 17
Sun, C., Zhu, B., Zhu, S., Zhang, L. J., Du, X., & Tan, X. (2021) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph19010355 · Cited by 16
“Eleftheriou [39] and Yoon [40] both pointed out smoking was detrimental to BMD but another study showed it was not significantly associated with BMD reduction in postmenopausal women and men of age over 50 years [41].”
Background
Metadata
- Authors
- Yoon, V., Maalouf, N. M., & Sakhaee, K.
- Affiliations
- The University of Texas Southwestern Medical Center (US)
- Corresponding author
- Sakhaee, K.
- Venue
- Osteoporosis International
- Published
- 2012-02-21
- Volume
- 23
- Issue
- 8
- Pages
- 2081-2092
- ISSN
- 0937-941X (ISSN-L)
- 1433-2965
- OpenAlex
- W2142262092
- Cited by
- 268
- References
- 134
- Citations by year
- 2026: 14 · 2025: 25 · 2024: 20 · 2023: 25 · 2022: 26 · 2021: 18 · 2020: 21 · 2019: 23 · 2018: 15 · 2017: 13 · 2016: 13 · 2015: 14 · 2014: 18 · 2013: 16 · 2012: 7
- FWCI
- 3.12
- Type
- journal article
- Language
- en
- Open access
- closed
- Licence
- www.springer.com/tdm (tdm)
- Locations
- Osteoporosis International (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Amgen
- Topics
- Health Sciences › Medicine › Orthopedics and Sports Medicine › Bone health and osteoporosis research
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Biology › Bone Metabolism and Diseases
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Smoking Behavior and Cessation
- Keywords
- cigarette smoking, osteoporosis, bone metabolism, bone mineral density, fracture risk, sex hormones, RANK/RANKL/OPG system, calcium absorption, smoking cessation, bone loss
- MeSH terms
- Adrenal Cortex Hormones, Adult, Aged, Aged, 80 and over, Animals, Bone and Bones, Calcitriol, Female, Humans, Male, Middle Aged, Osteoblasts, Osteoclasts, Osteoporosis, Parathyroid Hormone, Gonadal Steroid Hormones, Smoking, Bone Density, Smoking Cessation, Intercellular Signaling Peptides and Proteins, Young Adult, Osteoporotic Fractures
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