Smoking and Osteoporosis: How Smoking Affects Bone Health

Smoking most obviously affects the heart and lungs, and puts you at a greater risk for developing lung diseases and lung cancer. But it can also affect bone health. Studies have shown that tobacco use can lead to osteoporosis, a disease that can decrease bone density and cause the bones to become brittle and break.

Our bones are a framework that supports our bodies and allows us to move. Smoking cigarettes can have direct and indirect effects on bone density, which eventually impact your ability to move around safely. You can decrease your risk for developing osteoporosis by adopting a healthy diet, exercising regularly, and not smoking.

This article will discuss the impact of smoking on osteoporosis, ways to improve bone health, and how to quit smoking.

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How Smoking Affects Bone Density

​​The exact mechanisms by which smoking affects bone density are still being studied, but there is evidence to show that there is a link between smoking and decreased bone density.

Studying the effects of smoking on bone density has been a historically challenging topic, since people who smoke are more likely to have other risk factors for osteoporosis, like poor diet and exercise habits.

Despite these challenges, recent research suggests that there are specific direct and indirect factors that lead to bone loss as a result of smoking.

The direct effects are a result of chemical changes that occur when the nicotine from cigarettes attaches to bone cells called osteoblasts, eventually killing the cells.

There are four different types of bone cells, which include:

  • Osteoblast: Work to build new bone tissue
  • Osteoclast: Absorb and remove unwanted tissue
  • Osteocyte: Help maintain bone as living tissue
  • Hematopoietic: Produce red blood cells, white blood cells, and platelets

Although bones appear to be hard, static objects within our bodies, they are really made up of living tissues that are constantly regenerating or “remodeling.” During the process of bone remodeling, osteoblasts work hard to make sure that strong, new bone tissue is made, while osteoclasts make sure that any old or unwanted bone tissue is removed.

Smoking can disrupt the process of bone remodeling, leading to weak, brittle bones. 

Indirect Effects of Smoking

Smoking can also indirectly affect bone health, as it causes lower body weight, increased oxidative stress, and hormone disruption.

Smoking and Bone Fracture Risk

Smoking can increase the risk of developing osteoporosis and cause bone fractures in both women and men.

One study looking at hip fractures found that the increased risk of osteoporosis caused by cigarettes could reach 40% in men and 31% in women.

Smoking can increase the risk for fractures and slow the healing process. In fact, it can take almost twice as long for a person who smokes to heal from a bone fracture, compared to someone who does not smoke.

The reality of living with osteoporosis can be physically and mentally challenging. Recovering from broken bones can be painful, and for those who smoke cigarettes, it can be an especially long process. The increased risk of bone fractures can stop people from doing activities they once enjoyed. This can affect quality of life, and in some people, may even lead to anxiety and depression.

Ways to Improve Bone Health

The possibility of an osteoporosis diagnosis can be overwhelming. Fortunately, it’s not too late to work toward improving your bone health now.

There are lifestyle changes you can start today that will help to build stronger bones for the future. These include:  

  • Eat a healthy diet rich in fruits and vegetables. Look for foods that are high in calcium and vitamin D. If you are having trouble reaching the recommended levels, consider taking a supplement to improve your intake.
  • Participate in regular physical activity. Experts recommend 30 minutes of physical activity a day. The best types of exercise for bone health are low-impact, weight-bearing exercises, and resistance exercises. It's always best to consult your healthcare provider before beginning a new exercise regime, especially if you are at risk for osteoporosis.
  • Reduce alcohol consumption. Drinking alcohol in excess can affect your balance and increase your chances of falling and breaking a bone. Alcohol can also inhibit the absorption of calcium within the body, which can lead to bone loss.
  • Talk to your healthcare provider about a bone density test. These are also known as bone mineral density (BMD) tests.
  • Quit smoking. If you smoke cigarettes, quitting smoking now can slow the progression of smoking-related bone loss.

Tips for Quitting Smoking

If you are thinking about quitting smoking, there are some helpful tips to help you get started.

Remember, everyone has a different experience with quitting. Be patient with yourself and try not to compare your experience to anyone else's. This is your opportunity to quit in a way that works for you.

  • Choose a quit date. Commit to a quit date. Give yourself enough time to prepare but not so much time that you talk yourself out of it.
  • Make a plan. Smoking is both mental and physical. Consider how you would like to manage the physical cravings for nicotine and how you are going to change your daily behaviors related to smoking.
  • Manage stress. Stress can trigger cigarette cravings. Think about healthier strategies for relieving stress.
  • Ask for support. Reach out to family members, friends, or connect with a support group to lean on during the quitting process. If you prefer a virtual option, there are online support apps available.
  • Consider medication. There are various options for nicotine replacement, including prescriptions you can take to help you manage nicotine cravings. Medication is a tool to help you reach your goal; it is not an "easy way out."
  • Reward yourself. Quitting smoking is hard work. Celebrating the successes along the way can help you to stay motivated.

A Word From Verywell

We can't see or feel bone loss within our bodies. The first sign of osteoporosis is usually a broken bone that leads to another, and so on. Positive health changes like eating healthy and doing regular physical activity can help to improve bone health.

Smoking is a major risk factor for developing osteoporosis. By quitting smoking now you are doing your future self a favor and decreasing your risk of avoidable bone mass loss later in life. Quitting smoking is not easy, but it is possible.

Frequently Asked Questions

  • How does smoking affect the skeletal system?

    Smoking increases the risk for bone fractures in both women and men. The healing process for broken bones can take nearly twice as long in people who smoke, compared to people who do not smoke.

  • Can smoking increase bone mass loss?

    Yes, smoking can and does increase bone mass loss. It occurs when nicotine enters the body and interrupts the regular bone regeneration process. Over time, this leads to a decrease in bone mass, and increases the risk for developing osteoporosis.

5 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Hernigou J, Schuind F. Tobacco and bone fracturesBone Joint Res. 2019;8(6):255-265. doi:10.1302/2046-3758.86.BJR-2018-0344.R1

  2. Al-Bashaireh AM, Haddad LG, Weaver M, Chengguo X, Kelly DL, Yoon S. The effect of tobacco smoking on bone mass: an overview of pathophysiologic mechanismsJ Osteoporos. 2018;2018:1-17. doi:10.1155/2018/1206235

  3. Johns Hopkins Medicine. Anatomy of the bone.

  4. National Osteoporosis Foundation. Overall health.

  5. NIH Osteoporosis and Related Bone Diseases National Resource Center. Calcium and vitamin D: important at every age.

Additional Reading

By Teresa Maalouf, MPH
Teresa Maalouf is a public health professional with six years of experience in the field. She has worked in research, tobacco treatment, and infectious disease surveillance. Teresa is focused on presenting evidence-based health information in a way that is clear and approachable.