Smoking and Bone Health: How Cigarettes Weaken Your Bones

Does smoking cause bone loss and osteoporosis?

Yes — smoking is one of the most consistently recognised lifestyle causes of weaker bones. The NHS lists smoking, alongside heavy drinking, among the lifestyle factors that increase the likelihood of developing osteoporosis. NHS Across the research literature it is almost universally identified as a risk factor for low bone mineral density and increased fracture risk. BoneKEy Reports, 2014

Bone is living tissue that is constantly broken down and rebuilt, and healthy bones depend on that renewal staying in balance. Smoking tips the balance the wrong way, so more bone is lost than is replaced — the underlying process behind osteoporosis.

Importantly, some of smoking's harm is independent of bone density itself. Smoking is among the clinical risk factors that give information about fracture risk over and above what a bone-density measurement alone would predict. Osteoporosis International, 2005 That is exactly why current smoking is included as one of the clinical risk factors in the FRAX fracture-risk assessment used across the UK. Archives of Osteoporosis (NOGG), 2025 You can read more about how that works in our guide to fracture risk and FRAX.

How does smoking weaken your bones?

Smoking damages bone through several overlapping mechanisms rather than one single pathway. Together they slow the building of new bone, speed its breakdown, and starve it of the raw materials and blood supply it needs.

The main routes described in the research are:

• Slowing the bone-building cells. Nicotine is linked to reduced bone formation by osteoblasts — the cells that lay down new bone — while smoking pushes the balance toward resorption (breakdown). BoneKEy Reports, 2014
• Lowering oestrogen. Smoking reduces oestrogen, in part by suppressing the enzyme aromatase, and oestrogen is a key protector of bone in women. Genes (Basel), 2022 The Royal Osteoporosis Society adds that smoking slows the cells that build bone and raises the chance of an earlier menopause. Royal Osteoporosis Society
• Reducing calcium and vitamin D. Intestinal calcium absorption is lower in smokers than in non-smokers, and smoking is associated with reduced vitamin D — both of which limit the supply of what bone needs to stay strong. BoneKEy Reports, 2014
• Oxidative stress and cell signalling. In laboratory and mechanistic studies, smoking raises oxidative stress and shifts the RANKL/OPG signalling ratio in favour of bone resorption. Genes (Basel), 2022

Much of this mechanistic detail comes from laboratory work rather than long-term human fracture studies, so it is best understood as how smoking plausibly harms bone — while the fracture numbers below tell us how much it matters in practice.

How much does smoking increase your risk of fractures?

A UK evidence briefing puts current smokers at roughly a 25% higher risk of any fracture, with hip-fracture risk raised further still. According to the National Centre for Smoking Cessation and Training, current smokers have about a 25% higher risk of any fracture, and their hip-fracture risk is raised by roughly 40–84% — rising to over 100% in people over the age of 85. NCSCT

Those figures come from a single summary that draws together earlier meta-analyses, so they are best read as an evidence-based estimate of the scale of the effect rather than a precise personal prediction. What is clear is the direction and rough size: smoking meaningfully raises fracture risk, and the effect is largest for the hip and in the oldest age groups. If you want to understand what puts a person at higher risk more broadly, our guide to the signs of osteoporosis is a good next read.

Does smoking affect how broken bones heal?

Yes — smoking not only makes fractures more likely, it also slows and impairs their healing. The same UK briefing reports that smoking delays and impairs bone healing after a fracture. NCSCT One plausible reason is that smoking reduces the blood supply to bone — the delivery system that healing tissue depends on. NCSCT This is why surgical and orthopaedic teams often raise smoking as a factor before a planned operation.

Does secondhand (passive) smoking affect bone health?

It may — the early evidence points that way, but it is not yet firm. A 2023 cross-sectional study of women found that osteoporosis was significantly more common in passive smokers than in never-smokers, with odds comparable to those of current smokers. Journal of Endocrinological Investigation, 2023

Can quitting smoking improve your bone health?

The evidence is genuinely encouraging: smoking's effects on bone appear at least partly reversible. Ex-smokers sit between current smokers and never-smokers on both fracture risk and bone density, and stopping smoking reduces ongoing bone loss. NCSCT At the biological level, stopping smoking has been shown to reduce bone-turnover markers, consistent with the breakdown-versus-building balance shifting back toward normal. Genes (Basel), 2022

UK osteoporosis guidance backs this up: the 2024 national guideline recommends offering smoking-cessation advice and states that smoking cessation has been demonstrated to reduce the risk of vertebral and hip fractures in women. Archives of Osteoporosis (NOGG), 2025

The honest caveat is that "partly reversible" is not the same as "back to normal": because ex-smokers' risk and density stay intermediate, some of the benefit takes time to build and some may not fully reverse. That is still a strong reason to stop — the sooner the better. Your GP or a free NHS stop-smoking service can help you make a plan and stick to it.

How do you find out where your bones stand?

You cannot feel your bone density — the only way to know it is to measure it. If you smoke, have smoked, or live with other risk factors, a baseline measurement turns guesswork into a number you can act on and track over time.

A bone health assessment combines a bone-density measurement with your personal risk factors — age, family history, menopause status, medications and lifestyle — so you understand where you stand. Screen My Bones uses REMS (Radiofrequency Echographic Multi Spectrometry), a radiation-free ultrasound technology. Because it involves no ionising radiation, a REMS scan is a practical way to establish a baseline and monitor how your bones change over time — for example, in the months and years after you quit. It complements, rather than replaces, your GP and NHS stop-smoking support.

---

This article is part of our bone health series. To understand the wider picture, read our guide to what causes osteoporosis.