Smoking and Bone Health

Close-Up Of Young Man Smoking Outdoors

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It's common knowledge that smoking cigarettes is hazardous to health, increasing the risk of lung cancer, for example, and contributing to heart disease. What may be less well known is that smoking can be equally harmful to bone health. Smoking can slow the rate at which a broken bone mends, for example, and interfere with recovery from orthopedic surgery, adding yet more reasons for smokers to kick the habit, for non-smokers to never start, and for parents and caregivers to discourage children and teens from lighting up as well.

As of Dec. 20, 2019, the new legal age limit is 21 years old for purchasing cigarettes, cigars, or any other tobacco products in the U.S.

Effect on Bones

Because they're such hard structures, it may seem like bones would be impervious to the harms that smoking can cause. But like all tissues and organs in the body, bones are nourished by a steady flow of blood-bringing nutrients—such as minerals like calcium—and oxygen.

The active ingredient in cigarette smoke, nicotine, causes blood vessels to constrict to approximately 25% of their normal diameter. This interferes with the amount of blood that reaches bones and effectively deprives them of adequate nourishment. Without a healthy blood supply, bones that are injured cannot heal as quickly or, in some cases, as completely as they otherwise would.


There is plenty of research demonstrating the impact of smoking on bone healing. In a study comparing smokers with non-smokers who had surgery to treat wrist injuries, 95% of the non-smokers healed completely, while only 68% of the smokers healed completely. What's more, it took the smokers who did heal completely two months longer to recover.

Similarly, a review of studies looking at the effects of smoking on people who've undergone shoulder surgery to repair a rotator cuff found that smokers with rotator cuff tears had overall poor outcomes and decreased biomechanics.

Another review concluded that smoking impaired healing of tibia fractures (broken shin bones). Healing time was longer even among ex-smokers.

A Word From Verywell

If you're a smoker and you break, fracture, or otherwise injure a bone, it would be ideal if at all possible to kick the habit or at least try not to smoke until you're fully healed. Doing so will increase your chances of recovering completely, shorten the amount of time it takes for your bone to mend, and make it more likely you'll be satisfied with your outcome.

If you are going to have orthopedic surgery, your surgeon is likely to recommend you quit smoking weeks to months in advance. If you can be an ex-smoker by the time you have surgery, and you don't smoke during recovery, you're likely to improve your healing time and surgical success.

3 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. Sørensen LT, Jørgensen S, Petersen LJ, et al. Acute effects of nicotine and smoking on blood flow, tissue oxygen, and aerobe metabolism of the skin and subcutis. J Surg Res. 2009;152(2):224-30. doi:10.1016/j.jss.2008.02.066

  2. Chen F, "Smoking and bony union after ulna-shortening osteotomy" Am J Orthop. 2001 Jun;30(6):486-9.

  3. Santiago-Torres J, Flanigan DC, Butler RB, Bishop JY. "The effect of smoking on rotator cuff and glenoid labrum surgery: a systematic review." Am J Sports Med. 2015 Mar;43(3):745-51. doi:10.1177/0363546514533776.

Additional Reading

By Jonathan Cluett, MD
Jonathan Cluett, MD, is board-certified in orthopedic surgery. He served as assistant team physician to Chivas USA (Major League Soccer) and the United States men's and women's national soccer teams.