Osteoporosis is a common disorder of bone predominantly affecting postmenop
ausal women in which bone mineral density declines making bone more likely
to break. Although cigarette smoking is a well-established risk factor for
osteoporosis, smokeless tobacco (ST) use has never been suggested or evalua
ted as a risk factor for this bone disorder. This would be important to con
sider since in certain regions of the world, ST use is more prevalent than
cigarette smoking, particularly among women. This paper reviews the animal
and human evidence lending support to this new hypothesis, as well as the e
pidemiology of ST use that underscores the potential impact this modifiable
behavior might have on osteoporosis world wide. (C) 2001 Harcourt Publishe
rs Ltd.