Moderate-to-heavy smoking in women is potentially associated with compromised cortical porosity and stiffness at the distal radius
- 83 Downloads
Though smokers have poor clinical outcomes after treatment for fractures, the skeletal effects of smoking are still debated. Our results showed that female smokers had 33% higher cortical bone porosity. Smoking targets cortical compartment microstructure and mechanics, and micron-scale variables are essential to better understand the specific effects of smoking.
Smokers have poor outcomes in the clinic after treatment for fractures. However, skeletal effects of smoking are still debated. Inconsistencies in published data are likely due to macro-scale variables used to characterize bone differences due to smoking. Therefore, our goal was to characterize distal radius microstructure and macrostructure differences between smokers and non-smokers, and determine the degree to which smoking is associated with compartment-specific mechanical differences resulting from compromised cortical-trabecular microstructure.
Data were acquired from 46 female smokers (35 to 64 years old), and 45 age- and body mass-matched female non-smokers. Distal radius microstructure and mechanical variables were determined from high-resolution peripheral quantitative computed tomography (HR-pQCT) images and multiscale finite element analysis. Distal radius macro-scale variables (bone volume, bone mineral content, volumetric bone mineral density [vBMD]) were determined from low-resolution images.
Age- and body mass index-adjusted results showed that cortical porosity was 33% higher (p < 0.01), and that cortical vBMD and stiffness were 3% and 8% lower, respectively (p < 0.05), among smokers. We also observed unloading of the cortical compartment in smokers. There were no differences in the macro-scale variables. Average HR-pQCT-derived vBMD was 8% lower (p < 0.05) in smokers corresponding to 5 years of postmenopausal loss.
Skeletal effects of smoking become evident at the micron level through a structurally and mechanically compromised cortical compartment, which partially explains the inconsistent results observed at the macro-level, and the poor clinical outcomes. Smoking may also compound postmenopausal effects on bone potentially placing women having undergone menopause at a greater risk for fracture.
KeywordsNicotine FEM Osteoporosis High-resolution peripheral quantitative computed tomography
The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH. We would also like to thank Michael DiStefano, Megan Pinette, and Tyler Marshall for assistance with image processing, and John Wixted, MD, for his mentorship.
Research supported in this publication was supported by NIAMS of the National Institutes of Health under award number F32AR068839.
Compliance with ethical standards
The local IRB approved the study and all subjects provided written informed consent prior to participation.
Conflicts of interest
- 5.Kanis JA, Johnell O, Oden A, Johansson H, De Laet C, Eisman JA, Fujiwara S, Kroger H, McCloskey EV, Mellstrom D, Melton LJ, Pols H, Reeve J, Silman A, Tenenhouse A (2005) Smoking and fracture risk: a meta-analysis. Osteoporos Int 16:155–162. https://doi.org/10.1007/s00198-004-1640-3 CrossRefPubMedGoogle Scholar
- 17.Tsai JN, Uihlein AV, Burnett-Bowie SA, Neer RM, Zhu Y, Derrico N, Lee H, Bouxsein ML, Leder BZ (2015) Comparative effects of teriparatide, denosumab, and combination therapy on peripheral compartmental bone density, microarchitecture, and estimated strength: the DATA-HRpQCT Study. J Bone Miner Res 30:39–45. https://doi.org/10.1002/jbmr.2315 CrossRefPubMedPubMedCentralGoogle Scholar
- 19.Johnson JE, Troy KL (in Press 2017) Simplified boundary conditions alter cortical-trabecular load sharing at the distal radius; a multiscale finite element analysis. J BiomechGoogle Scholar
- 22.(2015) Massachusetts Department of Public Health. Who smokes. Massachusetts fact sheet. Massachusetts Behavioral Risk Factor Surveillance System. Massachusetts Department of Public Health, Tobacco Cessation and Prevention ProgramGoogle Scholar
- 23.(2014) U.S. Department of Health and Human Services. The health consequences of smoking—50 years of progress: a report of the Surgeon General. Atlanta: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and HealthGoogle Scholar
- 25.Dolan SH, Williams DP, Ainsworth BE, Shaw JM (2006) Development and reproducibility of the bone loading history questionnaire. Med Sci Sports Exerc 38:1121–1131. https://doi.org/10.1249/01.mss.0000222841.96885.a8 CrossRefPubMedGoogle Scholar
- 27.Hildebrand T, Rüegsegger P (1997) A new method for the model-independent assessment of thickness in three-dimensional images. J Microsc 185:67–75. https://doi.org/10.1046/j.1365-2818.1997.1340694.x CrossRefGoogle Scholar
- 28.Parfitt AM, Mathews CH, Villanueva AR, Kleerekoper M, Frame B, Rao DS (1983) Relationships between surface, volume, and thickness of iliac trabecular bone in aging and in osteoporosis. Implications for the microanatomic and cellular mechanisms of bone loss. J Clin Invest 72:1396–1409. https://doi.org/10.1172/jci111096 CrossRefPubMedPubMedCentralGoogle Scholar
- 30.Nishiyama KK, Macdonald HM, Buie HR, Hanley DA, Boyd SK (2010) Postmenopausal women with osteopenia have higher cortical porosity and thinner cortices at the distal radius and tibia than women with normal aBMD: an in vivo HR-pQCT study. J Bone Miner Res 25:882–890. https://doi.org/10.1359/jbmr.091020 CrossRefPubMedGoogle Scholar
- 34.Genant HK, Engelke K, Hanley DA, Brown JP, Omizo M, Bone HG, Kivitz AJ, Fuerst T, Wang H, Austin M, Libanati C (2010) Denosumab improves density and strength parameters as measured by QCT of the radius in postmenopausal women with low bone mineral density. Bone 47:131–139. https://doi.org/10.1016/j.bone.2010.04.594 CrossRefPubMedGoogle Scholar
- 36.Synek A, Chevalier Y, Baumbach SF, Pahr DH (2015) The influence of bone density and anisotropy in finite element models of distal radius fracture osteosynthesis: evaluations and comparison to experiments. J Biomech 48:4116–4123. https://doi.org/10.1016/j.jbiomech.2015.10.012 CrossRefPubMedGoogle Scholar
- 38.Khosla S, Riggs BL, Atkinson EJ, Oberg AL, McDaniel LJ, Holets M, Peterson JM, Melton LJ 3rd (2006) Effects of sex and age on bone microstructure at the ultradistal radius: a population-based noninvasive in vivo assessment. J Bone Miner Res 21:124–131. https://doi.org/10.1359/jbmr.050916 CrossRefPubMedGoogle Scholar
- 39.Lakens D (2013) Calculating and reporting effect sizes to facilitate cumulative science: a practical primer for t-tests and ANOVAs. Front Psychol 4. https://doi.org/10.3389/fpsyg.2013.00863
- 47.Bass S, Pearce G, Bradney M, Hendrich E, Delmas PD, Harding A, Seeman E (1998) Exercise before puberty may confer residual benefits in bone density in adulthood: studies in active prepubertal and retired female gymnasts. J Bone Miner Res 13:500–507. https://doi.org/10.1359/jbmr.19220.127.116.110 CrossRefPubMedGoogle Scholar