Evid Based Nurs 1:88 doi:10.1136/ebn.1.3.88
  • Causation

Review: smoking is associated with decreased bone mineral density and increased risk of hip fracture in postmenopausal women

 Question Does smoking lead to decreased bone mineral density and increased risk of hip fracture in premenopausal and postmenopausal women?

Data sources

Studies were identified from a Medline search using the terms smoking or tobacco combined with the terms bone density, osteoporosis, or hip fracture. References from relevant papers were also reviewed.

Study selection

Studies were selected if they assessed bone mineral density or hip fracture in women according to smoking habit. Studies of patients with specific diseases or those who started smoking later in life were excluded.

Data extraction

Data were extracted on age adjusted bone mineral density in the femoral neck, radius, or calcaneus; the difference between the mean bone mineral density of women who smoked and those who did not smoke; incidence of hip fracture; age adjusted relative risk (RR) of hip fracture based on smoking habit; and menopausal status.

Main results

29 cross sectional studies reported bone mineral density in 2156 women who smoked and 9705 women who did …

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