Like tobacco, vaping could weaken bone structure

A US study has found a correlation between e-cigarette use, bone fragility and fractures linked to osteoporosis, including in young adults.

Smoking is a recognized factor in osteoporosis and bone fragility.[1]. However, this type of pathology has not yet been demonstrated in the use of electronic cigarettes. A study involving a team of American researchers and a Cameroonian researcher now suggests that a link could also exist between the two.

A mechanism of action still not elucidated

The study used data from the National Health and Nutrition Examination Survey (NHANES), selecting a sample of 5,569 people over the age of 20, of whom 19% had vaped at least once in their lifetime and 8% had experienced bone fractures.[2]Fracture reports were more common among those who had vaped at least once, were currently vaping, or no longer vaped than among those who had never used an e-cigarette. However, the prevalence of bone fragility was higher among non-vaping smokers and those who used both cigarettes and e-cigarettes.

Bone fractures were considered osteoporosis-type bone fragility when caused by falls from low heights (from one's own height or from a seat) and have also been observed in young adults. The mechanism linking these types of fractures to e-cigarettes is still unknown and is not completely understood for conventional cigarettes either. For the latter, the possible explanations for bone fragility involve either a direct cytotoxic effect during osteoblastic activity (bone formation), or a disruption of metabolism and parathyroid hormones, which regulate vitamin D, cortisol and sex hormones. It is assumed that the action of e-cigarettes on bone fragility could follow the same principle as that of conventional cigarettes and could involve nicotine, subject to the intervention of other factors or substances.

Results to be considered with caution

The results of this study should be interpreted with caution, but indicate that the use of electronic cigarettes is far from being without health risks, as other studies on cardiovascular or respiratory diseases have pointed out. Several limitations of this study are highlighted by the authors, whether it concerns the characteristics of e-cigarettes, the extent of previous tobacco use, the importance of dual tobacco/e-cigarette use or self-reports by participants. The authors of the study also believe that treating physicians should systematically ask their patients about vaping, as they do for tobacco, and provide them with brief information on the risk of bone fragility.

For Patricia Folan, director of a tobacco center in New York State, "this study highlights the fact that e-cigarettes were brought to market prematurely and without regulation - based solely on the word of the manufacturers that they were safe and effective for smoking cessation."[3]Although there is still a lack of hindsight, a comprehensive scientific assessment of the health consequences of e-cigarettes is still lacking.

Keywords: fractures, bones, osteoporosis, e-cigarette, vaping, dual use

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[1] Kanis JA, Johnell J, Oden A, Johansson H, De Laet C, Eisman JA, et al., Smoking and fracture risk: a meta-analysis, Osteoporos Int, 2005 16 (2), 155-62. [2] Agoons DD, Agoons BB, Emmanuel KE, Matawalle FA, Cunningham JM, Association between electronic cigarette use and fragility fractures among US adults, American Journal of Medicine Open, preprint posted online November 13, 2021, accessed November 24, 2021. [3] Reinberg S, Vaping Could Weaken Your Bones, Study Finds, Health Day, published November 22, 2021, accessed November 24, 2021. National Committee Against Smoking |