Cigarette smoking and musculoskeletal disorders
Cigarette smoking is the largest cause of preventable deaths in the world. Besides its relation to many chronic diseases, smoking is also an important risk factor for conditions that jeopardize the duration and quality of life. Smoking has deleterious effects on the musculoskeletal system, and worsens the prognosis of several orthopaedic disorders and surgical procedures.
Smoking has a central role in the development of bone loss at all skeletal sites. Bone loss shows a positive relationship with the daily number of cigarettes smoked and years of exposure, and is independent from sex, age, weight, BMI, and several unhealthy lifestyle habits.
Several cellular studies show that nicotine directly stimulates bone metabolism at low doses, analogous to concentrations acquired by light smokers, and depress bone metabolism at high doses, analogous to concentrations acquired by heavy smokers.
Nicotine has also indirect negative effects on bone metabolism. It increases collagen degradation, and decreases oxygen supply, resulting from vascular damage. These experimental observations are widely accepted explanations for the association between smoking and musculo-skeletal diseases such as disc degeneration.
Several clinicians urge their patients to stop smoking before bone surgery is done. They feel that the incidence of delayed healing of bone graft procedures is so high that it would not be worth proceeding with surgery while the patient is still smoking. There is a need of controlled studies to state whether this can be considered scientifically proved. > From: Abate et al., Muscles Ligaments Tendons J 3 (2013) 63-69. All rights reserved to CIC Edizioni Internazionali.
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