It has been well-established that cigarette smoking is the
leading cause of preventable mortalities worldwide (Abate et al., 2013), but
what is the most important implication of cigarette smoking on morbidity and
quality of life? You most likely focused on the effects of smoking on the
cardiovascular system, but have you looked beyond the cardiovascular dimension?
A large quantity of experimental research indicates that cigarette smoking is a
prominent contributor to morbidity through its effects on the musculoskeletal
system. A recent review by Abate and colleagues (2013) investigated the effects
of cigarette smoking on the musculoskeletal system and the musculoskeletal
benefits associated with smoking cessation.
Cigarette smoking has been shown to decrease bone density through
both direct and indirect pathways (Abate et al., 2013). In vitro experiments
have demonstrated that at concentrations comparable to levels found in regular
smokers, nicotine directly suppresses bone metabolism (Abate et al., 2013). Cigarette
smoking has also been found to exhibit anti-estrogenic properties, which is
relevant to bone health because estrogen is known to contribute to maintaining
bone health in post-menopausal women (Abate et al., 2013). It was previously
discovered that smoking patients receiving estrogen-replacement therapy
required a greater dose of the hormone to achieve similar clinical results to
non-smoking patients receiving the standard dose of estrogen (Abate et al., 2013).
The negative impact of cigarette smoking on bone density has
numerous implications for one’s quality of life. Some of the downstream
outcomes of decreased bone density include an increased risk of fractures, poorer
prognosis following fractures, and an increased risk of back pain (Abate et
al., 2013). Moreover, meta-analyses have suggested that up to 25% of the burden
of rheumatoid arthritis in the population can be attributed to smoking (Abate
et al., 2013). Finally, studies have consistently found that cigarette smoking
is linked to muscle and tendon atrophy, with a dose-response relationship
observed between the daily number of cigarettes smoked and the severity of
tendon atrophy (Abate et al., 2013).
The good news is that smoking cessation has been linked with
noticeable short- and long-term musculoskeletal benefits. In the long-term,
smoking cessation has been associated with increased bone metabolism and a
decreased risk of fractures (Abate et al., 2013). The short-term benefits
include improved prognosis following orthopaedic surgery, reduced frequency of
musculoskeletal complication, and reductions in the length of hospital stays (Abate
et al., 2013). All the evidence
presented supports one of the main messages of Leave the Pack Behind, which is
that it is never too late to think about smoking cessation.
References
Abate M,
Vanni D, Pantalone A, Salini V. (2013). Cigarette smoking and
musculoskeletal disorders. Muscles,
Ligaments and Tendons Journal, 3(2), 63-9.
