THE EFFECTS OF SMOKING ON BONE MASS AND THE RATES OF BONE LOSS AMONG ELDERLY JAPANESE-AMERICAN MEN

Bone density and bone loss rates were examined among Japanese-American men categorized as current cigarette smokers, past smokers, and nonsm okers, The design included a retrospective study of smoking and bone d ensity and a prospective study of current smoking and bone loss rates, The mean length of follow-up was 5 years; the setting was the island of Oahu, The subjects included 1303 men in the Hawaii Osteoporosis Stu dy, 51-82 years old at their initial examination, Twenty percent were current smokers, 45% past smokers, and 35% had never smoked, Their bon e density was measured at the distal and proximal radius and calcaneus using single photon absorptiometry, Compared with never smokers, curr ent and past smokers had significantly lower bone density, especially in the predominantly cancellous calcaneus (4.8 and 4.3% lower, respect ively) and partially trabecular distal radius (1.8 and 3.3% lower, res pectively), The magnitude of the smoking effect was linked strongly to the duration of smoking and also to the number of cigarettes smoked, Bone loss rates subsequent to the initial measurement were greater in the current smokers than the never smokers (20.5, 27.2, and 9.7% great er at the calcaneus, distal, and proximal radius, respectively) but th e differences did not achieve significance, Smokers of more than one p ack per day had 32.0, 77.6, and 30.7% greater loss rates than never sm okers in these same sites; the difference achieved significance at the distal radius, The results fi om the distal radius suggest that these smokers may increase their fracture risk 10-30% per decade of smoking , The adverse effects of smoking appeared to be greater in cancellous than cortical bone.