A meta-analysis of smoking and fracture risk to update the FRAX® tool.

Unlabelled In this meta-analysis of international cohorts, current smoking is confirmed as a significant BMD-independent predictor of future fracture with a stronger relationship in men than in women. A causative and reversible effect of smoking on fracture risk is suggested by past smoking having a significantly lower risk than current smoking.Purpose In this meta-analysis of international cohorts, the aim was to examine the relationship of current and past smoking with fracture risk to provide an update for future iterations of the FRAX tool.Methods The risk of fracture associated with current and past smoking was estimated using an extended Poisson model applied separately to each of 58 prospective international cohort studies. Covariates included current time since start of follow up, current age, and in an additional model, BMD at the femoral neck. The results of the different studies were merged by using inverse-variance weighted β-coefficients.Results This analysis included a total of 1,691,024 participants (61.2% women, overall mean age 58.8 years). Current smoking, documented in 12.1% of all participants (15.2% and 10.1% respectively in men and women), was associated with a significantly increased risk of any clinical fracture, osteoporotic fracture, major osteoporotic fracture, and particularly hip fracture in both sexes. The hazard ratio (HR) for fracture was greater in men than in women for all fracture categories [e.g. hip fracture HR (95% confidence interval): 1.78 (1.58-2.00) vs. 1.64 (1.50-1.78)]. Low BMD explained about 19-54% of the increase in risk. When compared with never smoking, past smoking was associated with a significantly lower risk than current smoking [e.g. hip fractures for men, HR in past smokers: 1.08 (1.05-1.12) vs. 1.73, 95%CI (1.46-2.05) in current smokers].Conclusions Our results confirm the association between current smoking and increased fracture risk that is partly independent of BMD; these data will be used to inform future iterations of FRAX.

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Publication Details

Journal
Open Access CRIS of the University of Bern
Published
2026-03-04
DOI
https://doi.org/10.48620/95986
Primary Topic
Bone health and osteoporosis research
Type
article
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article

A meta-analysis of smoking and fracture risk to update the FRAX® tool.

Eric J. Shiroma, F A Anderson, Alyssa B. Dufour, Mark A. Kotowicz et al.
Open Access CRIS of the University of Bern
Bone health and osteoporosis research
article

A meta-analysis of smoking and fracture risk to update the FRAX® tool.

Eric J. Shiroma, F A Anderson, Alyssa B. Dufour, Mark A. Kotowicz, Fjorda Koromani, Charlotte Beaudart, Jacqueline R. Center, Rosemary Hollick, Olivier Bruyère, Jose ́ A. P. da Silva, Berit Schei, Marian Schini, Petra J. M. Elders, Cecilie L. Bager, Peter Nordström, Liesbeth Vandenput, Magnus K. Karlsson, MCarola Zillikens, Joan Vila, Enwu Liu, Heike A Bischoff-Ferrari, Eric S Orwoll, V Gudnason, Anne-Marie Schott, Anna Nordström, Woon-Puay Koh, Mari Hoff, Rafael Azagra-Ledesma, Marta Zwart, Emmanuel Biver, Roland Chapurlat, Heikki Kröger, Nicholas C Harvey, Claus-Christian Glüer, Tuan Vinh Nguyen, Junko Tamaki, Jane A. Cauley, Reijo Sund, Sophia Ish-Shalom, Masayuki Iki, Elisabeth Sornay-Rendu, William James Leslie, Cyrus Cooper, Timothy Kwok, Bess Dawson-Hughes, Sundeep Khosla (205804), Jill Hall, Julie A Pasco, Eleanor M Simonsick, Kristina E Åkesson, Mattias Lorentzon, Eugene V McCloskey, Claes Ohlsson, Graeme Jones, Nicole C Wright, David J Torgerson, Thomas Merlijn, Kristin Siggeirsdottir, Terence W O'Neill, Inbal Goldshtein, Claus Christiansen, Karin Ma Swart, John A Eisman, Bagher Larijani, Fernando Rivadeneira, Adolfo Diez-Perez, Serge Ferrari, Olivier Lamy, Helena Johansson, Steven R. Cummings, John A Kanis, Arnulf Langhammer, Saeko Fujiwara, Carolyn J Crandall, Natasja M van Schoor, Pawel Szulc, Fiona E A McGuigan, Yuki Fujita, Dan Mellström, Didier Hans, Martijn Huisman, David Goltzman, Nicholas J Wareham, Kurt Lippuner, Noriko Yoshimura, Douglas P Kiel, Barbara Obermayer-Pietsch, Tjeerd P van Staa
article en

Abstract

Unlabelled In this meta-analysis of international cohorts, current smoking is confirmed as a significant BMD-independent predictor of future fracture with a stronger relationship in men than in women. A causative and reversible effect of smoking on fracture risk is suggested by past smoking having a significantly lower risk than current smoking.Purpose In this meta-analysis of international cohorts, the aim was to examine the relationship of current and past smoking with fracture risk to provide an update for future iterations of the FRAX tool.Methods The risk of fracture associated with current and past smoking was estimated using an extended Poisson model applied separately to each of 58 prospective international cohort studies. Covariates included current time since start of follow up, current age, and in an additional model, BMD at the femoral neck. The results of the different studies were merged by using inverse-variance weighted β-coefficients.Results This analysis included a total of 1,691,024 participants (61.2% women, overall mean age 58.8 years). Current smoking, documented in 12.1% of all participants (15.2% and 10.1% respectively in men and women), was associated with a significantly increased risk of any clinical fracture, osteoporotic fracture, major osteoporotic fracture, and particularly hip fracture in both sexes. The hazard ratio (HR) for fracture was greater in men than in women for all fracture categories [e.g. hip fracture HR (95% confidence interval): 1.78 (1.58-2.00) vs. 1.64 (1.50-1.78)]. Low BMD explained about 19-54% of the increase in risk. When compared with never smoking, past smoking was associated with a significantly lower risk than current smoking [e.g. hip fractures for men, HR in past smokers: 1.08 (1.05-1.12) vs. 1.73, 95%CI (1.46-2.05) in current smokers].Conclusions Our results confirm the association between current smoking and increased fracture risk that is partly independent of BMD; these data will be used to inform future iterations of FRAX.

Open Access CRIS of the University of Bern
Good health and well-being
Openalex Percentile: Top 29%
Bone health and osteoporosis research
DOIOpen Access PDFOpenAlex
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