There is a direct relationship between smoking and decreased bone density, says research that has been confirmed by doctors in their clinical practice. In addition, smoking has indirect effects on bone health too, as a result of other unhealthy habits young smokers may pick up.
“Smoking has a negative effect on the bones, causing loss of bone mass, and eventually, premature osteoporosis, when young people take up smoking. We see that smoking as a habit begins in high school or the college years, when bones are still developing. This is alarming, because when bone density is low it makes the person more vulnerable to bone breaks at a young age,” says Dr Maninder Singh, an orthopaedic surgeon, who heads the Foot and Ankle Division at Indian Spinal Injuries Hospital, New Delhi.
UNESCO defines youth as people between 15 and 24 years, and “as a period of transition from the dependence of childhood to adulthood’s independence and awareness of our interdependence as members of a community.”
Bones are living organs that need constant growth, regeneration, and renewal. Bone mass is built with calcium, phosphorus, vitamin D and many other vitamins and minerals. The aim is to reach what physicians call peak bone mass, which is the maximum build up of bone in the skeletal mass. This takes place between the ages of 20 and 25. This is the point at which the bones are at their highest strength and density.
“In addition, other risk factors are often associated with smokers, such as the prevalence of risky behaviours such as drinking and substance abuse that also impacts bone health. Smokers most often abandon healthy habits such as exercise, even if they have been associated with sports in the past. Since exercise helps in bone development, they are, in effect, giving up on good bone health. Exercise also makes sure that people are out in the sun, raising vitamin D levels—another component for good bone health,” says Dr Singh.
Doctors talk of what is called a bone bank—the addition of various factors that grow bones: diet, exercise, sun exposure. The bank had deposits till the mid-20s, after which there is generally a depletion. Smoking decreases calcium absorption and reduces levels of vitamin D in the blood stream (the vitamin that facilitates bone building). Besides, the constriction of blood vessels that takes place in smokers, decreases blood supply, hence nutrition to the bone is compromised, hampering skeletal health. Cigarette smoke causes the circulation of free radicals in the body, killing bone-building cells. It also raises cortizol that adversely affects bones. The wrist and the neck of the femur are most prone to injuries, making a child more vulnerable to playground injuries..
“More alarming is fact that more and more young women have begun to take up the habit. As girls reach menarche, they need all the health and nutrition possible for optimal bone health, because they are the future bearers of children. Women smokers in India do stop smoking when they get pregnant, but that is not enough. A fetus derives its nutrition from the mother, and if the young woman does not have optimal bone density, she will end up with very weak bones at a young age,” says Dr Singh.
Worldwide, 82,000 to 99,000 young people start smoking every day, as per World Health Organization statistics. The Global Youth Tobacco Survey, of which India is a part, is a school-based survey conducted in 137 countries, indicates that 46.8% of children who did not smoke themselves were exposed to cigarette smoke within the home and 47.8% were exposed outside the home. In India, the survey produced representational data that implied 4.4% of children in India between 13 and 15 years smoked cigarettes.