Impact of current and previous smoking on fracture risk in older women: the role of physical function, bone density, and bone microarchitecture
Main finding · Any fractureResult — go to the resultHazard ratio 1.35 95% CI 1.04–1.75Authors' conclusion
These findings demonstrate that smoking is associated with increased fracture risk in older women, partly through impairments in physical function and vBMD.
Study context
- Population
- Community-dwelling Swedish women aged 75–80 yr
- Participants
- 3,024 women
- Exposure
- Current and former smokers vs never smokers
- Current smokersn = 157
- Former smokersn = 1,343
- Never smokersn = 1,524reference
- Outcome
- Radiographically verified fractures
- Follow-up
- Median 7.3 yr
Methodological detailscommunity-dwelling, mediation analyses, competing risk models
- Community-dwelling
- Mediation analyses
- Competing risk models
Main finding
Any fracture
Hazard ratio
1.35
95% CI 1.04–1.75
Current smokersvs Never smokers
HR 1.35 (95% CI 1.04–1.75)
As reported in the abstract
Observational data: associations, not effects.
Further findings
| Outcome | HR (95% CI) | |
|---|---|---|
| Hip fractureCurrent smokersvs Never smokers | 2.23 (1.43–3.49) | |
| 0.20.5125Hazard ratio (log scale) |
Smoking cessation
- Relative reduction in fracture and mortality risk per year since cessation
- ≈1%
- Ceased smoking for 5-10 yr: substantially lower fracture risk than current smokers
Mediation
- Indirect effect via slower walking speed
- 18%-28%
- Significant indirect effect via lower total volumetric BMD (vBMD)
Competing risk of mortality
- Elevated fracture risk in smokers confirmed after accounting for increased mortality
Original publication
Impact of current and previous smoking on fracture risk in older women: the role of physical function, bone density, and bone microarchitecture. J Bone Miner Res. Published 10 February 2026. doi:10.
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