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

DOI
Publisher DOI
PubMed ID
41779026
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.
Date Issued
2026-04
Publication Type
Article
Subject(s)
Subjects
Bone mineral density
•
Epidemiology
•
FRAX
•
Fracture
•
Osteoporosis
•
Smoking
Language(s)
en
Author(s)
Schini, Marian
Johansson, Helena
Harvey, Nicholas C
Lorentzon, Mattias
Liu, Enwu
Vandenput, Liesbeth
Leslie, William D
Åkesson, Kristina E
Anderson, Fred A
Azagra-Ledesma, Rafael
Bager, Cecilie L
Beaudart, Charlotte
Bischoff-Ferrari, Heike A
Biver, Emmanuel
Bruyère, Olivier
Cauley, Jane A
Center, Jacqueline R
Chapurlat, Roland
Christiansen, Claus
Cooper, Cyrus
Crandall, Carolyn J
Cummings, Steven R
da Silva, José A P
Dawson-Hughes, Bess
Diez-Perez, Adolfo
Dufour, Alyssa B
Eisman, John A
Elders, Petra J M
Ferrari, Serge
Fujita, Yuki
Fujiwara, Saeko
Glüer, Claus-Christian
Goldshtein, Inbal
Goltzman, David
Gudnason, Vilmundur
Hall, Jill
Hans, Didier
Hoff, Mari
Hollick, Rosemary J
Huisman, Martijn
Iki, Masayuki
Ish-Shalom, Sophia
Jones, Graeme
Karlsson, Magnus K
Khosla, Sundeep
Kiel, Douglas P
Koh, Woon-Puay
Koromani, Fjorda
Kotowicz, Mark A
Kröger, Heikki
Kwok, Timothy
Lamy, Olivier
Langhammer, Arnulf
Larijani, Bagher
McGuigan, Fiona E A
Mellström, Dan
Merlijn, Thomas
Nguyen, Tuan V
Nordström, Anna
Nordström, Peter
Obermayer-Pietsch, Barbara
Ohlsson, Claes
O'Neill, Terence W
Orwoll, Eric S
Pasco, Julie A
Rivadeneira, Fernando
Schei, Berit
Schott, Anne-Marie
Shiroma, Eric J
Siggeirsdottir, Kristin
Simonsick, Eleanor M
Sornay-Rendu, Elisabeth
Sund, Reijo
Swart, Karin Ma
Szulc, Pawel
Tamaki, Junko
Torgerson, David J
van Schoor, Natasja M
van Staa, Tjeerd P
Vila, Joan
Wareham, Nicholas J
Wright, Nicole C
Yoshimura, Noriko
Zillikens, MCarola
Zwart, Marta
Kanis, John A
McCloskey, Eugene V
Additional Credits
Journal
Osteoporosis International
Publisher
Springer
ISSN
1433-2965
0937-941X
Access(Rights)
restricted
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