The detrimental effects of smoking on the body are widely recognized. However, not everyone is aware of the harmful impact smoking can have on the musculoskeletal system. Surprisingly, research conducted by the Italian Society of Orthopaedics and Traumatology (SIOT) revealed that only 61 percent of adults are aware of this association.

The Effects of Smoking on Bone Health

While it may seem peculiar, bones are made of living matter that undergoes daily reshaping. Osteoblasts, the cells responsible for this process, utilize vitamin D and calcium to construct the bone matrix—the supportive structure of our bones. 

To carry out their role effectively, osteoblasts rely on oxygen supplied through the bloodstream. Unfortunately, smoking disrupts the microcirculation, depriving osteoblasts of the necessary energy to build the bone matrix. Moreover, inhaling carbon monoxide from smoking further diminishes the oxygen supply, impairing the body’s ability to incorporate calcium into bones and maintain strength and health.

Smoking Effects on Bone Health 

Smoking has three significant consequences on bones: 

  • Increased risk of osteoporosis. Smoking raises the likelihood of developing osteoporosis, a condition characterized by decreased bone density and heightened vulnerability to fractures.
  • Impaired healing and prolonged recovery time. Smoking slows down the body’s repair processes, doubling the time it takes for fractures to heal, scars to close, and muscles, ligaments, or tendons to recover.
  • Complications with joint replacements and reconstructive surgeries. In cases involving hip, shoulder, or knee joint replacements and reconstructive surgeries, smoking’s impact on microcirculation hampers the bone’s ability to integrate with the prosthetic properly. Consequently, the functionality of the prosthesis is severely compromised, as it lacks stable fixation and may require reoperation over time.

Therefore, It is always advised that patients quit smoking as a prerequisite for prosthesis surgery. Although approximately 50 percent of patients resume smoking after the initial three months, about 20 percent successfully left for good, which is still a remarkable achievement.

Smoking and Bone Health in Young Individuals

The risks to bone health caused by smoking apply equally to young individuals, especially those who are heavy smokers during adolescence.

According to experts, excessive smoking during the developmental years hinders the deposition of calcium in the bones, which is crucial for maintaining a strong bone matrix. In young smokers, this process of calcium depletion occurs earlier and at an accelerated pace, even before the completion of skeletal development. Specifically:

  • For girls, the deficit begins after menarche
  • For boys, the lack typically occurs around the age of 17-19

Young smokers, in particular, should exercise caution when it comes to cruciate ligament rupture. Apart from the general adverse effects, smoking can also impede or permanently hinder the return to sports activities following such an injury.