IOF LogoIOF World Congress on Osteoporosis 2004, May 14-18, 2004, Rio de Janeiro, Brazil
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Research presented at the IOF World Congress on Osteoporosis confirms that smoking and abdominal obesity are incompatible with strong bones.

May 17, 2004

Smoking at any time during one's life is a risk factor for osteoporosis, according to a major study presented this week at the IOF World Congress on Osteoporosis (IOF-WCO) in Rio de Janeiro, Brazil. In another important study of modifiable 'lifestyle' risk factors, researchers traced a link between atherosclerosis and bone loss in women back to a common cause -- abdominal obesity.

Multinational study strengthens case against smoking

The evidence that smoking increases the risk of osteoporosis has been controversial, with conflicting results from a series of small studies. The largest study to date now tips the balance in favor of a risk association.

In an oral presentation at the IOF-WCO, Dr. John Kanis, director of the WHO Collaborating Centre for Metabolic Bone Diseases at Sheffield University in England, and an IOF Board member, described the results of a meta-analysis of nearly 60,000 subjects (74 percent women) drawn from ten prospectively studied cohorts around the world.

Kanis and colleagues found that smoking -- whether in the past or currently -- was associated with a higher risk of fractures. "Smoking can now join the list of risk factors that aid in the identification of patients at high risk who should receive treatment to reduce fracture risk," said Kanis.

To some extent, smoking seems to exert its negative effects by helping to lower bone mineral density, but that is not the entire story. Smoking also appears to have other effects that increase the risk of fractures. These could range from increasing the risk of falls by diminishing muscle strength to reducing physical activity, perhaps due to other smoking-related diseases.

Obesity links atherosclerosis to low bone mass in hip

Two serious and ominous health complications have recently been linked. Researchers have found that women with low hip bone mineral density (BMD) were more likely to suffer from atherosclerosis.

In another presentation from the same IOF World Congress on Osteoporosis session (oral presentation OC16), Dr. László Tankó of the Center for Clinical and Basic Research in Ballerup, Denmark, suggested that abdominal obesity and its accompanying disruptions in fat metabolism might be an underlying cause of both low BMD and cardiovascular disease in women.

Tankó and his colleagues studied more than 450 postmenopausal women followed over nine years, assessing waist to hip ratio circumference, bone mineral density, and various biochemical markers associated with bone turnover and cardiovascular disease. They found that abdominal obesity was associated with decreases in a beneficial protein called Apo AI.

Apo AI is known to make complexes with HDL, or 'good,' cholesterol -- higher levels of the protein are believed to be protective against cardiovascular disease. The Danish team found that low levels of Apo AI, in turn, were associated with increased atherosclerosis and loss of bone from the hip. This raises the possibility of future therapies aimed at raising Apo AI levels to protect against both low hip BMD and atherosclerosis.

These results have immediate clinical implications for two groups of patients. "If clinicians find low hip BMD, they should perform diagnostic tests for undetected cardiovascular disease," said Tankó. "Conversely, patients with peripheral vascular disease should be checked for hip bone status to evaluate the need for active medication to prevent potential fractures."

Beyond the clinic, the link to obesity provides an opportunity for prevention. "Considering that cardiovascular disease and hip fracture are both major causes of death among the elderly, the results re-emphasize the need for advocating primary prevention--exercise and healthy nutrition to decrease upper-body obesity," said Tankó.


The International Osteoporosis Foundation (IOF) is a worldwide organization dedicated to the fight against osteoporosis. It brings together scientists, physicians, patient societies and corporate partners. Working with its 165 member societies in more than 85 locations, and other healthcare-related organizations around the world, IOF encourages awareness and prevention, early detection and improved treatment of osteoporosis.

Osteoporosis, in which the bones become porous and break easily, is one of the world's most common and debilitating diseases. The result: pain, loss of movement, inability to perform daily chores, and in many cases, death. One out of three women over 50 will experience osteoporotic fractures, as will one out of eight men(1). Unfortunately, screening for people at risk is far from being a standard practice. Osteoporosis can, to a certain extent, be prevented, it can be easily diagnosed and effective treatments are available.

1 Melton U, Chrischilles EA, Cooper C et al. How many women have osteoporosis? Journal of Bone Mineral Research, 1992; 7:1005-10

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International Osteoporosis Foundation:

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