The use of cigarettes over a long period has detrimental
effects on bone mass. These effects may be mediated directly, by toxic effects
on osteoblasts, or indirectly by modifying estrogen metabolism. On average,
cigarette smokers reach menopause 1–2 years earlier than the general population.
Cigarette smoking also produces secondary effects that can modulate skeletal
status, including intercurrent respiratory and other illnesses, frailty,
decreased exercise, poor nutrition, and the need for additional medications
(e.g., glucocorticoids for lung disease).
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