Four Effects of Smoking on Your Bones and Joints

We all know that smoking is not good for your health. It causes lung cancer, strokes and coronary heart disease, to name just a few.

However, many people don’t realise that smoking is also harmful to your musculoskeletal system. Smoking can increase your risk of developing bone and joint conditions, and can also have an impact on your recovery from a musculoskeletal injury or surgery.

In this article we discuss a number of the problems smoking can have on your bones and joints.

Back Pain

According to research conducted by Petre et al from Northwestern University Feinberg School of Medicine in 2014, people with sub-acute back pain who smoked were three times more likely to progress to persistent back pain than non-smokers¹. MRI findings indicated that smoking is changing how the pain signal is interpreted and processed in the brain, but further research is required to fully understand what is happening.

Studies have also shown that smoking may be directly responsible for intervertebral disc degeneration as it causes cell damage in the annulus and nucleus.

Smokers are more likely to suffer overuse injuries such as bursitis or tendonitis, and traumatic injuries such as sprains and fractures, than non-smokers. Fractures and broken bones take longer to heal in smokers, and for some people broken bones do not heal in smokers. This slow bone healing is due to nicotine negatively effecting the production of bone-forming cells. In addition, smokers who do heal are more likely to have persistent pain and other complications afterwards.

There is growing evidence that cigarette smoking adversely affects spinal fusion healing. New bone growth is necessary for a fusion to heal and smoking disrupts the body’s system that contribute to bone formation and growth.  


Smoking leads to an increased risk of developing osteoporosis, a weakness of bone that causes fractures. People with osteoporosis have a much higher risk of fractures, particularly of the hip and vertebra. Women who smoke also tend to have an earlier menopause than non-smokers, another risk factor for osteoporosis.

The tobacco in cigarettes decreases your bone density as it adversely affects your bone cells. It reduces the blood supply to your bones, it slows the production of bone-forming cells (osteoblasts) so they make less bone, it reduces calcium absorption required for bone mineralisation, and it increases the speed at which oestrogen is broken down, a hormone that helps protect your bones.

Evidence of smoking causing decreased bone mineral density and roughly one in eight hip fractures was demonstrated in a meta-analysis in 1997 of 29 published cross-sectional studies². They concluded that the cumulative excess bone loss over decades is substantial and by age 80 this can translate into 6% lower bone mineral density. Hip fracture risk among smokers compared to non-smokers is estimated to be 17% greater at age 60, 41% greater at 70, 71% greater at 80, 108% greater at 90.

Rotator cuff (shoulder) tears

Studies have suggested that smoking is associated with the development of rotator cuff tears and often smokers develop larger tears than non-smokers.

Nicotine is a potent vasoconstrictor and decreases the delivery of oxygen to tissues as well as carbon monoxide decreasing cellular oxygen tension levels necessary for cellular metabolism, and is probably related to tendon quality in smokers.

Some research has also shown a negative correlation with tobacco consumption and wound repair at surgical sites. Nicotine delays and inhibits tendon to bone healing, which is required to recover from rotator cuff surgery.

Rheumatoid arthritis

Rheumatoid arthritis (RA) is a chronic inflammatory autoimmune disease caused by both genetic and environmental factors. RA causes your body’s immune system, that normally protects your body from attacks by foreign substances, to mistakenly attack your joints and causes swelling and pain in and around them.

Smoking has been implicated as one of the most important risk factors for RA development and severity. Smokers also have an increased risk of more-severe rheumatoid arthritis and they are less likely to experience remission. Smoking decreases the effectiveness of some drugs used to treat RA.

Many people with rheumatoid arthritis aren't aware that smoking is making their condition worse.




Register your interest to hear from us