Musculoskeletal Effects of Cigarette Smoking

It is well known that cigarette smoking is implicated in lung cancer, respiratory conditions, cardiovascular disease and impaired immunity.  Heavier smokers (over a pack a day) also create a hypoxic state (lack of oxygen) in the body, which can be attributed to other health issues.  Researchers reviewed the current literature to specifically look at the effects of cigarette smoking on the musculoskeletal system and here are some of their findings: 

Bone Metabolism and Fracture Risk: Smoking appears to affect both osteoblasts and osteoclasts, both of which are important for balanced bone health, and can lead to a decrease in bone mineral density (osteoporosis).  This leads to an increased risk of fracture of the hip, spine, and radius. 

Fracture Healing:  Smoking leads to reduced blood supply and local tissue hypoxia, which increases fracture healing time, and increases the risk of poor healing, infection, and non union of fractures. 

Soft Tissue Healing:  Smokers tend to have delayed wound and soft tissue healing of tendons and ligaments, a higher risk of tendon injuries, increased wound infections and complications compared to non smokers.  Smokers have been shown to have a higher incidence of rotator cuff tears.

Back Pain:  The increased levels of pro inflammatory mediators by smokers can amplify pain as well smoking appears to be associated with an increase risk of degenerative disc disease and low back pain.  However, it is difficult to say how smoking is associated with low back pain, as smokers often have worse health, both mentally and physically, than non smokers. 

Arthritis:  There is an unclear relationship with smoking and osteoarthritis as some studies have shown increased knee cartilage loss in smokers, but it is an accepted risk factor for rheumatoid arthritis.  Smokers have also been shown to have a greater chance of developing lupus, an inflammatory autoimmune disorder.

Perioperative Management:  The negative effects of smoking on wound healing appear to improve after 4 weeks of smoking cessation.  Former smokers tend to do better than current smokers in terms of improved recovery from surgical wounds and have less post operative complications.  It would therefore be highly recommended that smokers cease smoking at least 4 weeks prior to any surgery. 

There are many health reasons to quit smoking, now we can add musculoskeletal conditions to the list!

Citation: Lee et al, The Musculoskeletal Effects of Cigarette Smoking; Journal of Bone and Joint Surgery (Am) 2013; 95: 850-859.