A meta-analysis of cigarette smoking, bone mineral density and risk of hip fracture: recognition of a major effect
A meta-analysis of cigarette smoking, bone mineral density and risk of hip fracture: recognition of a major effect
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DOI：
10.1136/bmj.315.7112.841
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发表时间：
1997-10-04
影响因子：
105.7
通讯作者：
Hackshaw, AK
中科院分区：
文献类型：
--
作者：
Law, MR;Hackshaw, AK
目的：根据年龄确定吸烟、骨密度和髋部骨折风险之间关系的大小和重要性。设计：荟萃分析29项已发表的横断面研究，报告2156名吸烟者和9705名不吸烟者的年龄差异，以及19项队列和病例对照研究，记录吸烟者和非吸烟者髋部骨折的风险。结果：在绝经前女性中，吸烟者和不吸烟者的骨密度相似。现在的吸烟者比不吸烟者的绝经后骨丢失更严重，骨密度每增加10岁就额外减少约2%，80岁时的差异为6%。在目前吸烟者中，髋部骨折的风险在50岁时与非吸烟者相似，但在60岁时估计增加了17%，70岁时增加了41%，80岁时增加了71%，90岁时增加了108%。这些根据年龄对吸烟和髋部骨折研究的回归分析直接得出的相对风险估计，接近于使用吸烟者和不吸烟者之间的骨密度差异以及骨密度与髋部骨折风险之间的关系进行估计。据估计，英国85岁以下女性患髋部骨折的累积风险在吸烟者中为19%，而在非吸烟者中为12%；在90岁之前，吸烟者和非吸烟者的累积风险分别为37%和22%。在所有女性中，每八个人中就有一个髋部骨折可归因于吸烟。有限的数据表明，男性吸烟的比例效应与女性相似。这种联系不能用吸烟者更瘦、更年期更年轻、运动更少，也不能用吸烟对雌激素的作用来解释，但吸烟可能对骨骼有直接作用。结论：老年髋部骨折是绝经后吸烟的主要不良影响。几十年来累积的过量骨丢失是巨大的，使髋部骨折的终生风险增加了约一半。
Objective: To determine the magnitude and importance of the relation between smoking, bone mineral density, and risk of hip fracture according to age.Design: Meta-analysis of 29 published cross sectional studies reporting the difference in bone density in 2156 smokers and 9705 non-smokers according to age, and of 19 cohort and case-control studies recording 3859 hip fractures reporting risk in smokers relative to non-smokers.Results: In premenopausal women bone density was similar in smokers and non-smokers. Postmenopausal bone loss was greater in current smokers than non-smokers, bone density diminishing by about an additional 2% for every 10 year increase in age, with a difference of 6% at age 80. In current smokers relative to non-smokers the risk of hip fracture was similar at age 50 but greater thereafter by an estimated 17% at age 60, 41% at 70, 71% at 80, and 108% at 90. These estimates of relative risk by age, derived directly from a regression analysis of the studies of smoking and hip fracture, were close to estimates using the difference in bone density between smokers and non-smokers and the association between bone density and risk of hip fracture. The estimated cumulative risk of hip fracture in women in England was 19% in smokers and 12% in non-smokers to age 85; 37% and 22% to age 90. Among all women, one hip fracture in eight is attributable to smoking. Limited data in men suggest a similar proportionate effect of smoking as in women. The association was not explained by smokers being thinner, younger at menopause, and exercising less nor by actions of smoking on oestrogen, but smoking may have a direct action on bone.Conclusions: Hip fracture in old age is a major adverse effect of smoking after the menopause. The cumulative excess bone loss over decades is substantial, increasing the lifetime risk of hip fracture by about half.