Smoking osteoporosis

Despite the limitations imposed by the physiology of the skin, several marketed controUed release transdermal dmg dehvery systems are available in the United States for example, scopolamine [51-34-3] for the treatment of motion sickness, nitroglycerin [55-63-0] for angina, estradiol [50-28-2] for the rehef of postmenopausal symptoms and osteoporosis, clonidine [4205-90-7] for the treatment of hypertension, fentanyl [437-38-7] as an analgesic, and nicotine [54-11-5] as an aid to smoking cessation. These systems are designed to dehver dmg for periods of one to seven days. 

Many of the risk factors for osteoporosis and osteoporotic fractures are predictors of low bone mineral density, such as age and ethnicity (Table 53-1). The most important risk factors for fracture are low bone mineral density, personal history of adult fracture, age, and family history of osteoporotic fracture. Other important risk factors for osteoporosis and osteoporotic fractures include menopausal status, smoking status, and low body weight. As bone mineral density decreases, the risk of fracture increases. However, the threshold at which individual patients develop a fracture varies, and other factors may play a role in fracture susceptibility. One such factor that can influence the development of fracture is falling. 

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. 

Assess patient risk factors for osteoporosis, with special attention to age, menopausal status, previous history of osteoporotic fracture, smoking status, low body weight, family history of osteoporotic fracture in first-degree relatives, and presence of secondary causes of osteoporosis. 

Daniell, H., Osteoporosis and the slender smoker vertebral compression fractures and loss of metacarpal cortex in relation to postmenopausal cigarette smoking and lack of obesity, Archives of Internal Medicine, 136, 298, 1976. 

Daniell, H. W. 1983. Postmenopausal tooth loss. Contributions to edentulism by osteoporosis and cigarette smoking. Arch. Intern. Med 143, 1678-1682. 

Dietary choices, sedentary occupations and lack of exercise are responsible for obesity and associated conditions including cardiovascular diseases and diabetes. Smoking, excessive alcohol intake and improper drug use curtail both life and its quality. As life expectancy increases it is mirrored by the increase in degenerative diseases such as arthritis, osteoporosis, cardiovascular disease, cancer, hearing and eyesight decline, and brain cell deterioration (Alzheimer s). 

Tobacco smoking inhibits the activity of osteoblasts and is an independent risk factor for osteoporosis. Smoking also results in increased breakdown of exogenous oestrogen, lower body weight and earlier menopause, aU of which contribute to lower BMD. 

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. 

Patient assessment should begin with identifying risk factors for osteoporosis and fractures (see Table 88-1). Important points include age, history of nontraumatic adult fractures, family history of osteoporosis or fragility fractures, comorbid medical and mental illnesses, lifestyle habits (diet, physical activity, smoking, and alcohol use), menstrual history, fall risk, prior and current medications (especially... 

Adequate calcium and vitamin D intake (see Table 88-4) should be assured. For seniors with severe osteoporosis, a 25(OH) vitamin D concentration should be used to guide vitamin D supplementation. Centenarians have a particularly high rate of hypovitaminosis D. Smoking cessation and exercise begun late in life still have positive bone effects. 

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. 

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