The musculoskeletal effects of cigarette smoking

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.

Smoking up... what's the harm?

Almost all young adults are aware of the consequences of smoking cigarettes on health. However, the risks associated with smoking marijuana and the effects it has on social smoking of tobacco products are far less known.

Marijuana is an illegal tobacco alternative that is used by some university students. Like cigarettes, marijuana contains many chemicals – specifically, up to 400 different chemicals can be found in marijuana.

Compared to smoking cigarettes, smoking a marijuana joint:

• Puts 5 times more carbon monoxide in your bloodstream

• Puts 3 times more tar in your lungs

In addition, smoking one joint is the equivalent to smoking 2.5-5 cigarettes with respect to decreased lung function and obstructing airflow. The smoke from marijuana joint contains 50-70% higher levels of cancer causing chemicals.

Compared to a cigarette smoker, someone who smokes five joints a week would be taking in as many cancer causing chemicals as a cigarette smoker who smokes a pack a day! People who use marijuana regularly are also more likely to become dependent on marijuana, and may experience irritability, anxiety, cravings, and sleep disturbances when they try to quit using marijuana. Since smokers are more likely to also become dependent on marijuana, avoiding the use of marijuana products when you are trying to quit smoking can increase your chance of success!


Do you want to try quitting, cutting back, or eliminating marijuana use when you drink alcohol? Register for the wouldurather... contest by January 27, 2014 and you could win $750!

References: Aldington et al. (2008). Cannabis use and risk of lung cancer: A case-control study. Eur Respir J, 31(2):280-286.


Rickert, Robinson & Rogers. (1982). A comparison of tar, carbon-monoxide and ph levels in smoke from marijuana and tobacco cigarettes. Can J Public Health, 73:386-391.


Swift et al. (2008). Adolescent cannabis users at 24 years: trajectories to regular weekly use and dependence in young adulthood. Addiction, 103:1361-1370.


Vandrey et al. (2008). A within-subject comparision of withdrawal symptoms during abstinence from cannabis, tobacco, and both substances. Drug Alcohol Depend, 92:48-54.


Wu et al. (1988). Pulmonary hazards of smoking marijuana as compared with tobacco. New Engl J Med, 318:347-352.