Cigarette smoking contributes to osteoporosis, as well as a host of other medical conditions. Perhaps concern about osteoporosis will be the final thing that will convince patients to stop smoking.
There are now many studies that show negative effects of cigarette smoking on the bone. One longitudinal study of 116,229 female nurses found the age-adjusted relative risk for hip fracture was 1.3 in current smokers. Ten years after smoking cessation, the risk was reduced. Part of the risk was explained by changes in body weight (Cornuz J).
The graph is based on relative risks from a meta-analysis of 50,232 men and women around the world, showing rates of hip fractures in smokers vs non-smokers. The risk of any osteoporotic fracture, and especially hip fracture, is increased in smokers. The relative increase was attenuated after adjustment for bone density, but still in older men and women the fracture risk was about 60% higher in smokers than in non-smokers (Kanis JA).