Effect of Smoking on Osteoporotic Vertebral Fracture in Postmenopausal Women

Sang-Pil Yoon; Seung-Hwan Lee; Byeong-Mun Park; Kyung-Sub Song; Geun Jang; Beom-Seok Lee; Hwan-Mo Lee; Seong-Hwan Moon

doi:10.4184/jkss.2016.23.1.1

Journal List > J Korean Soc Spine Surg > v.23(1) > 1076088

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Yoon, Lee, Park, Song, Jang, Lee, Lee, and Moon: Effect of Smoking on Osteoporotic Vertebral Fracture in Postmenopausal Women

Original Article

Journal of Korean Spine Surg 2016;23(1):1-6.

Published online: 31 March 2016

DOI: https://doi.org/10.4184/jkss.2016.23.1.1

Effect of Smoking on Osteoporotic Vertebral Fracture in Postmenopausal Women

Sang-Pil Yoon, M.D., Seung-Hwan Lee, M.D., Byeong-Mun Park, M.D., Kyung-Sub Song, M.D., Geun Jang, M.D., Beom-Seok Lee, M.D., Hwan-Mo Lee, M.D.^∗, Seong-Hwan Moon, M.D.^∗

Department of Orthopaedic Surgery, Gwangmyeong Sungae Hospital

^∗Department of Orthopaedic Surgery, Yonsei University College of Medicine

Corresponding author: Kyung-Sub Song, M.D. Department of Orthopaedic Surgery, Gwangmyeong Sungae Hospital, 36 Digital-ro, Gwangmyeong 14241, Korea TEL: +82-2-2680-7699, FAX: +82-2-2680-7755 E-mail: sksub@paran.com

Received 1 February 20156 May 2015 Accepted 10 September 2015

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Study Design

A retrospective study.

Objectives

To evaluate the association between smoking and osteoporotic vertebral fractures (OVFs) in postmenopausal women.

Summary of Literature Review

Several studies have examined the relationship of smoking with hip fractures, but few studies have analyzed the relationship of smoking with spine fractures in women thus far.

Materials and Methods

This study considered 1255 postmenopausal women aged 50 years and older (enrollment from April 2008 to January 2009) from 62 study sites in a nationwide hospital. The amount of smoking was calculated in pack-years. Further, OVFs were diagnosed using a semi-quantitative method. To analyze the relationship between smoking and OVFs, we used a paired t-test, a ^χ2-test, and a binary logistic regression analysis.

Results

The past history of smoking was 7.2% in the patient group and 4.3% in the control group (p=0.025). The mean pack-years of smoking was 0.34 in the control group and 0.62 in the patient group (p=130). The mean T-score in the lumbar bone mass density (BMD) was −1.64 in the control group and −2.19 in the patient group (p=0.409). Smoking was a risk factor of vertebral fractures in postmenopausal women (odd's ratio=1.68, 95% confidence interval=1.020–2.759, p=0.042) irrespective of the lumbar BMD and the medical treatment for osteoporosis and obesity.

Conclusions

Smoking is a risk factor for osteoporotic vertebral fractures in postmenopausal women independently without regard to lumbar BMD. Therefore, cessation of smoking is important for the prevention of OVFs in postmenopausal women.

Keywords: Osteoporotic vertebral fracture, smoking, bone mineral density

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Table 1.

Comparison of bone mineral density between control and vertebral fracture group

	Control group(714)	Vertebral fracture group(531)	p-value
Age	61.29±7.16	65.75±7.65	<0.001
Height (cm)	155.71±5.17	154.65±5.32	0.001
Weight (kg)	58.07±8.00	56.67±8.83	0.008
Body mass index (kg/m²)	23.96±3.15	23.68±3.42	0.173
Smoking (pack year)	0.34±2.63	0.63±3.41	0.130
Lumbar BMD (mg/cm²)	0.90±0.17	0.83±0.19	<0.001
Lumbar BMD (T-score)	−1.64±1.35	−2.19±1.43	<0.001
Femur neck BMD (mg/cmm²)	0.74±0.18	0.67±0.20	<0.001
Femur neck BMD (T-score)	−1.34±1.12	−1.96±1.25	<0.001
Total femur BMD (mg/cm²)	0.80±0.16	0.74±0.22	<0.001
Total femur BMD (T-score)	−1.03±1.19	−1.62±1.24	<0.001

BMD, bone mineral density.

Table 2.

Comparison of binary variables between control and vertebral fracture group

	control group(714)	Vertebral fracture group(531)	Odds ratio	p-value
Osteoporosis (T-score≤-2.5)	217(30.3%)	249(46.3%)	1.985	<0.001
Treatment of osteoporosis	568(79.2%)	341(63.4%)	0.454	<0.001
History of smoking	31(4.3%)	39(7.2%)	1.730	0.025
Obesity (BMI≥25)	236(33.1%)	177(33.3%)	0.999	0.995

BMI, body mass index.

Table 3.

Relative risk of smoking on vertebral fracture by logistic regression analysis controlling osteoporosis and obesity

	Odds ratio	95% CI	p-value
Osteoporosis (T-score≤-2.5)	1.74	1.362-2.224	<0.001
Treatment of osteoporosis	0.508	0.392-0.660	<0.001
History of smoking	1.677	1.020-2.759	0.042
Obesity (BMI≥25)	1.181	0.921-1.513	0.190

Table 4.

Comparison of bone mineral density and prevalence of vertebral fracture between non-smoking group and smoking group

	non-smoking group(1203)	smoking group(73)	p-value
Lumbar BMD (mg/cm²)	0.87±0.19	0.82±0.19	0.006
Lumbar BMD (T-score)	−1.87±1.42	−2.43±1.42	0.001
Femur neck BMD (mg/cm²)	0.71±0.19	0.70±0.20	0.789
Femur neck BMD (T-score)	−1.60±1.21	−1.92±1.42	0.035
Total femur BMD (mg/cm²)	0.77±0.19	0.72±0.17	0.042
Total femur BMD (T-score)	−1.26±1.26	−1.72±1.35	0.003
Prevalence of vertebral fracture	511(42.3%)	40(54.8%)	0.036

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