Conventional cigarettes increase the risk of osteoporosis and osteoporotic fracture, among other negative effects. But the effect of e-cigarettes, often marketed as a safer alternative to traditional cigarettes, on bone health has been unknown. That is changing. Recent lab studies suggest the liquids in e-cigarettes are toxic to cells and bone.
When researchers at the University of Pittsburgh Medical Center looked at the association between e-cigarette use and fracture risk among adults in the U.S., they found e-cigarette use increased the risk of fragility fractures — fractures of the hip, spine or wrist resulting from minimal trauma, such as a fall from standing height or less.
Most of the e-cigarette users in the United States are between 18 and 25 years old, well under the age when bone health becomes a concern. The new findings suggest that young people who vape could be increasing their risk for osteoporotic fracture as they age.
E-cigarette use increased the risk of fragility fractures — fractures of the hip, spine or wrist resulting from minimal trauma, such as a fall from standing height or less.
Data from more than 5,500 adult men and women enrolled in the National Health and Nutrition Examination Survey were analyzed for the study. More than 4,500 people (about 81 percent of the study population) reported they never used e-cigarettes, more than 1,000 people (almost 19 percent) said they currently used e-cigarettes or had used them in the past, and more than 440 people (eight percent) reported they had sustained fragility fractures.
Former or current e-cigarette users had a 46 percent higher incidence of self-reported fragility fractures than those who never tried e-cigarettes. Those who smoked traditional cigarettes had a 63 percent higher incidence of self-reported fragility fractures compared to those who never smoked cigarettes or tried e-cigarettes. And those who used e-cigarettes and smoked had more than twice the incidence of self-reported fragility fractures than those who only smoked.
The findings did not surprise the researchers. “There have been reports in the literature of an association between e-cigarettes use and delayed post-operative bone healing,” explained Agoons, adding that observational studies have found an association between e-cigarette use and other conditions such as chronic obstructive pulmonary disease, depression and cardiovascular disease. Further research will be needed to determine exactly how e-cigarettes negatively affect bone health and increase the risk of fractures.
The team recommends that healthcare providers, particularly primary care providers, consider e-cigarette use a risk factor for fractures in their patients. Given the increasing popularity of e-cigarettes and the economic burden and morbidity and mortality associated with osteoporotic fractures, doctors — and their patients — should take the effect of e-cigarettes on bone density seriously.