A meta-analysis of smoking and fracture risk to update the FRAX® tool
Authors' conclusion
Our results confirm the association between current smoking and increased fracture risk that is partly independent of BMD; these data will be used to inform future iterations of FRAX.
Study context
- Population
- International cohorts (61.2% women, overall mean age 58.8 years)
- Participants
- 1,691,024 participants58 cohorts
- Comparison
- Current and past smoking vs never smoking
- Outcome
- Fracture risk (any clinical, osteoporotic, major osteoporotic and hip fracture) associated with current and past smoking
Methodological details58 prospective international cohorts, extended Poisson model, inverse-variance weighted β-coefficients, additional model adjusted for femoral neck BMD
- 58 prospective international cohorts
- Extended Poisson model
- Inverse-variance weighted β-coefficients
- Additional model adjusted for femoral neck BMD
Pooled result
As reported in the abstract
Hip fracture, current smoking, by sex
Current smoking vs Never smokingHazard ratio (95% CI)
Men
1.78(1.58–2.00)
Women
1.64(1.50–1.78)
- Current smoking prevalence
- 12.1%
- Current smoking prevalence, men vs women
- 15.2% vs 10.1%
Further pooled results
| Outcome | HR (95% CI) | |
|---|---|---|
| Hip fracture in men, past vs current smoking (vs never smoking)Past smokingvs Never smokingMen | 1.08 (1.05–1.12) | |
| Hip fracture in men, past vs current smoking (vs never smoking)Current smokingvs Never smokingMen | 1.73 (1.46–2.05) | |
| 0.512Hazard ratio (log scale) |
Proportion of increased risk explained by low BMD
- Low BMD explained about 19-54% of the increase in risk
Hip fracture in men, past vs current smoking (vs never smoking)
- Past smoking associated with significantly lower risk than current smoking
Original publication
A meta-analysis of smoking and fracture risk to update the FRAX® tool. Osteoporos Int. Published 4 March 2026. doi:10.
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