A study published in the Annals of the American Thoracic Society states that male smokers, with or without Chronic Obstructive Pulmonary Disease, had a significantly lower bone mineral density and a higher incidence of bone fractures than female smokers.

Osteoporosis is generally considered a women’s problem. However, according to the National Osteoporosis Foundation of the USA, about 25% of men over 50 will break a bone due to osteoporosis; this means that men are more likely to suffer a bone fracture than develop prostate cancer (the risk of developing prostate cancer in one’s lifetime is 14%).

One of the risk factors for osteoporosis is smoking. Chronic Obstructive Pulmonary Disease (COPD) is a serious consequence of smoking, and individuals suffering from COPD are known to be at a higher risk for bone fractures. Studies thus far have concentrated on active smokers with COPD, and men have generally not been included in the investigations. The current study set out to find the effect of both past and active smoking habits on the bone health of men and women.

For the study, conducted by the National Jewish Health, assessed the bone health of 3,321 men and women with COPD, aged 45-80. Volumetric bone mineral density (vBMD) was used as a parameter for testing bone density and was calculated by quantitative computed tomography or QCT. The vBMD was adjusted for age, gender, body mass index (BMI), smoking, glucocorticoid use, etc. The research team got the following surprising results:

• Low vBMD was present in 58% of participants.
  
• The severity of COPD determined the fragility of bones; an 84% low vBMD was observed in individuals with very severe COPD.
  
• Male smokers had an increased risk (55%) of low vBMD compared to women (40%).
  
• Men in the study were 60% more likely to develop vertebral fractures, compared to 40% women participants.

Talking about the results, the senior author of the study, Dr. Elizabeth Regan, said to National Jewish Health News, “….this points to the need for the U.S. Preventive Services Task Force, which last updated osteoporosis screening guidelines in 2011, to consider adding at-risk men to their screening guidelines, which now include only women.”

Dr. Regan adds, “I think that a sizeable number of men who have low bone density are not getting diagnosed, and they’re not getting treated. And so they’re sustaining fractures that they could avoid. We need to change that.”

In many instances, osteoporosis does not become apparent until an injury has already occurred. The authors, therefore, suggest that both men and women smokers be screened for low vBMD using QCT so that the healthcare providers could identify and treat osteoporosis. Prevention of fractures due to osteoporosis could save unnecessary suffering, valuable time, and cut losses due to health care costs and loss of productivity.

Written by Mangala Sarkar, Ph.D.

Primary Reference

Jaramillo, J., Wilson, C., Stinson, D., Lynch, D., Bowler, R., Lutz, S., . . . Regan, E. (2015). Reduced Bone Density and Vertebral Fractures in Smokers. Men and COPD Patients at Increased Risk. Annals of the American Thoracic Society, 12(5), 648-656.

Include Men In Osteoporosis Screening Guidelines. (n.d.). Retrieved August 13, 2015, from http://njhealth.multimedianewsroom.tv/story.php?id=957&enter=

DoveMed Resources

Osteoporosis - Primary (Type I). (n.d.). Retrieved August 14, 2015, from http://www.dovemed.com/osteoporosis-primary-type-i/

Osteoporosis - Secondary (Type II). (n.d.). Retrieved August 14, 2015, from http://www.dovemed.com/osteoporosis-secondary-type-ii/

Chronic Obstructive Pulmonary Disease (COPD). (n.d.). Retrieved August 14, 2015, from http://www.dovemed.com/diseases-conditions/chronic-obstructive-pulmonary-disease-copd/

Additional References

Just for Men. (n.d.). Retrieved August 14, 2015, from http://nof.org/articles/justformen

Surveillance, Epidemiology, and End Results ProgramTurning Cancer Data Into Discovery. (n.d.). Retrieved August 14, 2015, from http://seer.cancer.gov/statfacts/html/prost.html

Smoking and Bone Health. (n.d.). Retrieved August 14, 2015, from http://www.niams.nih.gov/Health_Info/Bone/Osteoporosis/Conditions_Behaviors/bone_smoking.asp