Smoking has a negative impact on bone health

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Dr. Mark Duber

Kentucky One Health

By now, most people are aware of the negative effects of smoking. From increased risk of cancer, stroke, heart disease, emphysema, asthma and more, smoking’s ill health effects are known by many. But did you know that smoking also has negative effects when it comes to your bones and muscles? Smoking slows bone healing, both in the short term and the long term, because it restricts circulation and lowers blood oxygen levels, and also leads to a number of other musculoskeletal problems.

If you are a smoker and fracture a bone, your fracture will take longer to heal than it would for a nonsmoker, due to the harmful effects of nicotine on the production of bone-forming cells. For foot or ankle surgery, smoking could even prevent the bones from healing, which is called a nonunion.

After the bone heals, smokers are also more likely to have persistent pain, because chemicals in cigarette smoke are believed to increase inflammation and affect the way the body interprets pain signals. Because of the effect smoking has on circulation and blood oxygen levels, it also impairs wound healing after surgery and raises the surgical complication rate.

Smoking has been shown to make it more difficult for your body to fight off an infection after surgery. Smokers who undergo surgery for musculoskeletal conditions whether for a foot, ankle or knee are more likely to experience other serious complications like blood clots, stroke and pneumonia.

Smoking also negatively impacts other tissues in the musculoskeletal system. For example, rotator cuff tears in the shoulder are nearly twice as large in smokers than in nonsmokers. Smokers are also more likely to suffer from overuse injuries like bursitis and tendonitis, as well as injuries like sprains and fractures. Smoking also increases the risk of developing osteoporosis.

If you smoke, there are still measures you can take prior to surgery and following surgery to help avoid these complications. Quitting smoking prior to surgery will help, even if it’s only four to six weeks in advance. Avoiding smoking after surgery will also help mitigate the chance of complications and help bones heal properly.

Even if you’re not undergoing a musculoskeletal surgery, smoking cessation will help prevent other issues like osteoporosis, overuse injuries and more.

There are many resources out there for those who want to quit smoking, from support groups to nicotine replacement options like patches and gum, as well as oral medications that can help ease symptoms of nicotine withdrawal.

If you need foot, ankle, or other orthopedic surgery and smoke, talk to a physician before surgery to determine what steps you can take to help reduce your risk of slow bone healing, complications related to wound healing, and more.

Mark Duber, MD, is an orthopedic surgeon and head of sports medicine orthopedics at Flaget Memorial Hospital, part of KentuckyOne Health.