It’s important to understand how smoking affects bone health, so that you can make the best decision for your health. First, smoking weakens bones by decreasing bone mineral density (BMD) by up to 2% compared to nonsmokers, leading to an increase in fractures. This dip occurs because nicotine leads to dips in estrogen and testosterone, which are necessary in maintaining bone density and strength. Smoking also reduces nutrient absorption, meaning your bones get less calcium and vitamin D needed to regenerate and heal.

With time, reduced bone density can lead to outright deterioration. Studies find that smokers are at increased risk of bone fracture; spine fractures occur 32% more frequently in men and 13% in women. The rates for hip fractures are similarly alarming—the increased risk caused by cigarettes are projected to reach 40% in men and 31% in women. Fractures aren’t just an inconvenience; they can have significant impacts on the body for years to come. A fifty year old woman is just as likely to die from a hip fracture than she is from breast cancer. At the end of the day, avoiding bone fractures is crucial for overall health, especially as we age.

Outside of the risk of bone fracture, smoking also leads to increased inflammation and oxidative stress, which eventually leads to bone loss. Chronic inflammation increases bone resorption into the body, while simultaneously decreases bone formation. In other words, little by little, your bones literally shrink. And in the face of serious injury, a smoker's bones don’t remodel quite right, often growing back weaker than before.

What exactly happens to smokers post injury? Smokers consistently have delayed recovery times, and in one study, some smokers suffered from fractures that never quite healed. For others, additional weeks were spent recovering from their injury, while non-smokers got back to their daily life. If surgery was required for fracture injuries, smokers also faced a higher risk of skin infection and scarring. To be clear, at every stage of the recovery process, smoking hurt overall health and harmed progress.

It isn’t just smoking, though! While less research exists on vaping’s impact on the bones, recent studies indicate that it’s just as harmful on bone health. Just as smoking reduces bone mineral density (BMD), so does vaping. While some research indicates that vaping can lead to a minor increase in bone mass, these bones are weaker on average. This is particularly alarming for young people, who vape at a significantly higher rate. These teens and young adults are more likely to develop weak bones as they are growing, leading to lifelong problems with bone health and an increased risk of developing osteoporosis early in life.

Vaping also poses its own unique challenges. Since vapes contain higher concentrations of nicotine, and vape users typically use their vape more frequently, rates of nicotine intake are, on average, much higher for vape users. Nicotine, in and of itself, reduces healthy bone formation; and vape users tend to suffer from nicotine induced problems more often than smokers. Moreover, vape aerosols contain heavy metals that are toxic to bones and can linger in the body for years to come. These metals include arsenic, chromium, nickel, and lead and have been found in vapers’ blood, urine, and saliva.

If you’re a longtime smoker or vaper, there is good news. Quitting smoking and vaping leads to an immediate improvement in bone density and growth, meaning you’ll be at less risk of fracture on day 1. If you’re not ready to quit, or you’re still on your journey, you can take extra steps to help support your body. Nutritional strategies, including Vitamin D and Magnesium supplements, have shown promising signs of increasing bone healing. And exercise, specifically weight bearing exercises, can strengthen bones and improve mobility and flexibility. Medical interventions, too, such as weekly and monthly pills or even IV infusions can build back bones.

At the end of the day, the best strategy for strong, healthy bones is to avoid smoking and vaping altogether. Don’t wait until you’re hobbling around on crutches like me; invest in your health and enjoy stronger bones, and ultimately, a stronger you.

Ready to quit but aren’t sure where to start? We can help. Jones combines FDA approved nicotine replacement therapy mints with real time digital behavioral support. You’ll find a community of quitters on our app, get answers to your questions from our AI Coach, Coach Jones, and even texts for a little extra help throughout the day. Wherever you are on your quitting journey, Jones is with you every step of the way.