It has long been suggested that smoking is directly toxic to bone, but the extent to which smoking increased fracture risk was uncertain. Now, a recent meta-analysis of studies from all over the world has found that smoking is associated with a significantly increased risk of hip and other osteoporotic fractures in both men and women. After adjusting for age and weight, the risk of hip fracture, for example, was 55% higher in smokers than in non-smokers.
Looking at the impact of smoking in another way, researchers Law and Hackshaw reported in 1997 that one hip fracture in eight is attributable to smoking, regardless of other risk factors.
Kanis, J.A., et al. 2005. Smoking and fracture risk: A meta-analysis. Osteoporos Int, 1(2), 155-162.
Law, M.R., Hackshaw, A.K. 1997. A meta-analysis of cigarette smoking, bone mineral density and risk of hip fracture: Recognition of a major effect. BMJ, 315, 841-846.