Smoking, bone loss

Some osteoporosis risk factors (see Table 53-1) are non-modifiable, including family history, age, ethnicity, sex, and concomitant disease states. However, certain risk factors for bone loss may be minimized or prevented by early intervention, including smoking, low calcium intake, poor nutrition, inactivity, heavy alcohol use, and vitamin D deficiency. 

Smoking cessation can help to optimize peak bone mass, minimize bone loss, and ultimately reduce fracture risk. 

Krall, E. A., and Dawson-Hughes, B. (1999). Smoking increases bone loss and decreases intestinal calcium absorption. JBMR 14,215-220. 

Postmenopausal women are vulnerable to osteoporosis, which largely involves trabecular bones including the spinal vertebrae. Estrogen deficiency plays a major role since estrogen replacement reduces the rate of bone loss. The mechanism for this effect has not been fully characterized but decreased estrogen resulted in increased IL-1 secretion from blood monocytes. IL-1 stimulates osteoclastic activity and bone resorption. Other risk factors include excessive alcohol consumption and smoking. 

Smoking cessation and minimal alcohol use should be advocated. Smoking causes bone loss and increases hip fracture risk by several mechanisms. Smoking is associated with early menopause. 

Once skeletal maiurily has been attained, it is the magnitude of the subsequent bone loss which may lead to osteoporosis. Tlie use of corticosteroid drugs should be minimized. Stopping smoking is impttrtant. At the menopause, hormone replacement iherapy is of benefit, not only for the relief of menopausal symptoms but also to prevent rapid bone loss. Indeed, cardiovascular protection also follows as an incidental benefit of such therapy. 

Bone loss causing secondary osteoporosis may be accelerated by a number of factors such as the use of corticosteroids, smoking and immobilization. 

Iqbal J, Sun L, Cao J, Yuen T, Lu P, Bab I, Leu NA, Srinivasan S, Wagage S, Hunter CA, Nebert DW, Zaidi M, Avadhani NG (2013) Smoke carcinogens cause bone loss through the aryl hydrocarbon receptor and induction of Cypl enzymes. Proc Natl Acad SciUSA 110 11115-11120... 

Facial characteristics are defined by the skin, muscles and bones. Over the years, the face loses its youthful appearance. Body weight, hormonal changes, ultraviolet radiation, smoking, and gravity lead to the appearance of depressions and wrinkles. In addition, the loss of the skin s elasticity becomes apparent after the age of 30. Areas of the face most affected are the periorbital, malar, forehead, temporal, glabellar, mandibular, mental and perioral zones [14-16]. 

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