The influence of thinness and smoking on bone loss and response to hormone replacement therapy in early postmenopausal women
Abstract
We studied the influence of thinness and smoking in 153 early postmenopausal women from a 3-yr period, comparing treatments of 1 or 2 mg estradiol with placebo. The baseline body mass index (BMI) was significantly associated with bone resorption (r = -0.26, P < 0.01 for urinary CrossLaps with 21% difference between extreme tertiles) with a consequent association between BMI and bone mineral density (BMD; r = 0.38, P < 0.001 for BMD of hip with 10% difference between extreme tertiles). A low BMI led to an increased rate of loss (r = 0.45, P < 0.01 for BMD of spine), whereas response to treatment with either 1 or 2 mg estradiol was independent of BMI. Smoking was associated with a 4% lower BMD at baseline compared with that in nonsmokers. This effect was additive with that of BMI. For smokers the increase in serum estradiol during hormone replacement therapy was only half of that in nonsmokers. For women treated with placebo or 2 mg estradiol, serum FSH levels were similar in smokers and nonsmokers, but during treatment with 1 mg estradiol, serum FSH was significantly less suppressed in smokers. This was mirrored in the BMD response, where smokers responded similarly to 2 mg estradiol and placebo as did nonsmokers, whereas smokers receiving 1 mg estradiol experienced only half the increase compared to nonsmokers. In conclusion, thinness and smoking are important risk factors for osteoporosis development, but are counteracted by hormone replacement therapy.
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In women, tobacco smoking enhances estrogen metabolism resulting in a lower level of estradiol.
“In women, tobacco smoking enhances estrogen metabolism resulting in a lower level of estradiol [52, 53].”
From The Effect of Tobacco Smoking on Bone Mass: An Overview of Pathophysiologic Mechanisms (2018) · cites this paper as [52]
In females, cigarette smoking causes a reduction in estrogen levels by altering estrogen metabolism.
“In females, CS causes a reduction in estrogen levels by altering estrogen metabolism [52,53].”
From An Overlooked Bone Metabolic Disorder: Cigarette Smoking-Induced Osteoporosis (2022) · cites this paper as [52]
Cites
Risk Factors for Hip Fracture in White Women
Cummings, S. R., Nevitt, M. C., Browner, W. S., Stone, K., Fox, K. M., Ensrud, K. E., Cauley, J., Black, D., & Vogt, T. M. (1995) · New England Journal of Medicine · doi:10.1056/nejm199503233321202 · Cited by 3,595 · see citing works
Onset of adolescent eating disorders: population based cohort study over 3 years
Patton, G. C., Selzer, R., Coffey, C., Carlin, J. B., & Wolfe, R. S. (1999) · BMJ · doi:10.1136/bmj.318.7186.765 · Cited by 708 · see citing works
Ravn, P., Cizza, G., Bjarnason, N. H., Thompson, D. E., Daley, M., Wasnich, R. D., McClung, M. R., Hosking, D., Yates, A. J. P., & Christiansen, C. (1999) · Journal of Bone and Mineral Research · doi:10.1359/jbmr.1999.14.9.1622 · Cited by 453 · see citing works
Self-citationDeterminants of bone density in normal women: risk factors for future osteoporosis?
Stevenson, J. C., Lees, B., Devenport, M., Cust, M., & Ganger, K. F. (1989) · BMJ · doi:10.1136/bmj.298.6678.924 · Cited by 406 · see citing works
Jensen, J., Christiansen, C., & Rødbro, P. (1985) · New England Journal of Medicine · doi:10.1056/nejm198510173131602 · Cited by 381 · see citing works
Self-citationPREDICTION OF RAPID BONE LOSS IN POSTMENOPAUSAL WOMEN
Christiansen, C., Riis, B. J., & Rødbro, P. (1987) · The Lancet · doi:10.1016/s0140-6736(87)91671-0 · Cited by 365 · see citing works
Self-citationRosenquist, C., Fledelius, C., Christgau, S., Pedersen, B. J., Bonde, M., Qvist, P., & Christiansen, C. (1998) · Clinical Chemistry · doi:10.1093/clinchem/44.11.2281 · Cited by 317 · see citing works
Self-citationSmoking Increases Bone Loss and Decreases Intestinal Calcium Absorption
Krall, E. A., & Dawson-Hughes, B. (1999) · Journal of Bone and Mineral Research · doi:10.1359/jbmr.1999.14.2.215 · Cited by 295 · see citing works
Bone mass and body composition in normal women
Lindsay, R., Cosman, F., Herrington, B., & Himmelstein, S. A. (1992) · Journal of Bone and Mineral Research · doi:10.1002/jbmr.5650070109 · Cited by 223 · see citing works
Trémollières, F., Pouillès, J. M., & Ribot, C. A. (1993) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jcem.77.3.8370689 · Cited by 213 · see citing works
Ribot, C., Trémollières, F., Pouilles, J., Bonneu, M., Germain, F., & Louvet, J. (1987) · Bone · doi:10.1016/8756-3282(87)90062-7 · Cited by 187 · see citing works
Bonde, M., Qvist, P., Fledelius, C., et al. (1995) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jcem.80.3.7883844 · Cited by 182 · see citing works
Measurement of a more stable region of osteocalcin in serum by ELISA with two monoclonal antibodies
Rosenquist, C., Qvist, P., Bjarnason, N. H., & Christiansen, C. (1995) · Clinical Chemistry · doi:10.1093/clinchem/41.10.1439 · Cited by 177 · see citing works
Self-citationCigarette smoking, obesity, and bone mass
Slemenda, C., Hui, S., Longcope, C., & Johnston, C. C. (1989) · Journal of Bone and Mineral Research · doi:10.1002/jbmr.5650040513 · Cited by 162 · see citing works
Smoking, smoking cessation, and risk of hip fracture in women
Cornuz, J., Feskanich, D., Willett, W. C., & Colditz, G. A. (1999) · The American Journal of Medicine · doi:10.1016/s0002-9343(99)00022-4 · Cited by 161 · see citing works
Ravn, P., Hetland, M. L., Overgaard, K., et al. (1994) · Journal of Bone and Mineral Research · doi:10.1002/jbmr.5650091218 · Cited by 110 · see citing works
Bone loss associated with a high fibre weight reduction diet in postmenopausal women.
Avenell, A., Richmond, P., Lean, M. E. J., & Reid, D. M. (1994) · PubMed · Cited by 87 · see citing works
Influence of soft tissue body composition on bone mass and metabolism
Hassager, C., & Christiansen, C. B. (1989) · Bone · doi:10.1016/8756-3282(89)90072-0 · Cited by 62 · see citing works
Self-citationIs Cigarette Smoking a Promoter of the Menopause?
Andersen, F. S., Transbel, I., & Christiansen, C. (1982) · Acta Medica Scandinavica · doi:10.1111/j.0954-6820.1982.tb03185.x · Cited by 55 · see citing works
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The effects of smoking on bone metabolism
Yoon, V., Maalouf, N. M., & Sakhaee, K. (2012) · Osteoporosis International · doi:10.1007/s00198-012-1940-y · Cited by 268 · see citing works
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Wong, P. K. K., Christie, J. J., & Wark, J. D. (2007) · Clinical Science · doi:10.1042/cs20060173 · Cited by 219 · see citing works
The Effect of Tobacco Smoking on Bone Mass: An Overview of Pathophysiologic Mechanisms
Al-Bashaireh, A. M., Haddad, L. G., Weaver, M., Chengguo, X., Kelly, D. L., & Yoon, S. (2018) · Journal of Osteoporosis · doi:10.1155/2018/1206235 · Cited by 209 · see citing works
Increased Bone Resorption in Moderate Smokers with Low Body Weight: The Minos Study
Szulc, P. (2002) · Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.87.2.666 · Cited by 144 · see citing works
Cusano, N. E. (2015) · Current Osteoporosis Reports · doi:10.1007/s11914-015-0278-8 · Cited by 100 · see citing works
Need, A. G., Kemp, A., Giles, N., Morris, H. A., Horowitz, M., & Nordin, B. E. C. (2002) · Osteoporosis International · doi:10.1007/s198-002-8342-9 · Cited by 102 · see citing works
Impact of Smoking Cessation on Bone Mineral Density in Postmenopausal Women
Oncken, C., Prestwood, K., Kleppinger, A., Wang, Y., Cooney, J., & Raisz, L. (2006) · Journal of Women's Health · doi:10.1089/jwh.2006.15.1141 · Cited by 79 · see citing works
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Weng, W., Li, H., & Zhu, S. (2022) · Genes · doi:10.3390/genes13050806 · Cited by 65 · see citing works
Kim, K. H., Lee, C. M., Park, S. M., Cho, B., Chang, Y., Park, S. G., & Lee, K. (2013) · Osteoporosis International · doi:10.1007/s00198-012-1987-9 · Cited by 52 · see citing works
- Authors
- Bjarnason, N. H., & Christiansen, C.
- Affiliations
- Center for Clinical & Basic Research (DK)
- ORCID
- Christiansen, Claus
- Venue
- The Journal of Clinical Endocrinology & Metabolism
- Publisher
- The Endocrine Society
- Published
- 2000-02
- Volume
- 85
- Issue
- 2
- Pages
- 590-596
- ISSN
- 0021-972X (ISSN-L)
- 1945-7197
- OpenAlex
- W2169664261
- Cited by
- 87
- References
- 19
- Citations by year
- 2025: 4 · 2024: 2 · 2022: 3 · 2021: 1 · 2020: 1 · 2019: 1 · 2018: 2 · 2016: 2 · 2015: 3 · 2014: 4 · 2013: 5 · 2012: 6
- FWCI
- 4.54
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- The Journal of Clinical Endocrinology & Metabolism (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Menopause: Health Impacts and Treatments
- Health Sciences › Medicine › Orthopedics and Sports Medicine › Bone health and osteoporosis research
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Genetics › Estrogen and related hormone effects
- Keywords
- thinness, smoking, bone loss, hormone replacement therapy, estradiol, postmenopausal women, body mass index, bone mineral density, osteoporosis risk factors, serum estradiol, FSH suppression, low-dose estradiol
- MeSH terms
- Body Weight, Estradiol, Female, Follicle Stimulating Hormone, Humans, Middle Aged, Smoking, Bone Density, Osteoporosis, Postmenopausal, Estrogen Replacement Therapy, Body Mass Index
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