E-cigarette consumption is linked to a higher prevalence of fragility fractures

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While conventional smoking is an established risk factor for osteoporosis and osteoporotic fracture, the effects of electronic cigarette (e-cigarette) use on bone health have not been studied previously. In a new study of more than 5,500 adult e-cigarette users across all age groups, investigators found that e-cigarette use was associated with a higher prevalence of fragility fractures. Their findings, published in the American Open Journal of Medicine, published by Elsevier, suggest that electronic cigarette use can be detrimental to bone health, even in young adults.

Fragility fractures are defined as a collection of self-reported fractures of the hip, spine, or wrist resulting from minimal trauma, such as a fall from a standing height or less.

Due to their attractive design and vapor delivery system, the use of electronic cigarettes has gained popularity. Since their introduction over ten years ago, electronic cigarettes have been marketed as a healthier alternative and a conventional smoking cessation aid. Electronic cigarettes contain a combination of propylene glycol, vegetable glycerin, and varying levels of nicotine and additives, generating a flavored vapor. While conventional smoking is an established risk factor for osteoporosis and osteoporotic fracture, the association between e-cigarette use and bone health, particularly fragility fractures, has not been studied previously. .

In my outpatient clinic, I saw a patient after surgery to repair a fractured femoral neck. She smoked and used electronic cigarettes to quit smoking. I realized that there was a lack of knowledge in the literature on the potential relationship between e-cigarettes and fragility fractures and decided to conduct this study. “

Dayawa D. Agoons, MD, MPH, Principal Investigator, Department of Medicine, UPMC Pinnacle, Harrisburg, PA, USA

Investigators conducted a cross-sectional analysis using 2017-2018 data from the National Health and Nutrition Survey (NHANES). Using a sample of more than 5,500 American adult men and women, they investigated the association between e-cigarette use and fragility fractures. There were 4,519 (81.2%) never users of electronic cigarettes, 1,050 (18.8%) never users of electronic cigarettes, and 444 (8.0%) with self-reported fragility fractures.

The results showed a higher prevalence of fragility fractures in e-cigarette users compared to non-users. The researchers also found that people who used both conventional cigarettes and e-cigarettes had a higher prevalence of fragility fractures compared to conventional smokers alone.

The prevalence of e-cigarette use is highest in the 18-25 age group in the United States. Therefore, this study suggests that young e-cigarette users may increase their risk of osteoporotic fractures over time. The investigators therefore recommend that healthcare providers, especially those who practice primary care, consider e-cigarettes as a potential risk factor for fragility fracture and include the risk of fracture in the potential negative consequences of e-cigarettes.

“To our knowledge, this is the first study to examine the relationship between e-cigarette use and fragility fractures,” commented Dr Agoons. “This fills a significant knowledge gap given the growing popularity of e-cigarette use and the significant economic burden as well as the known morbidity and mortality associated with osteoporotic fractures. of electronic cigarette use with reduced bone health. “

Previous observational studies have reported an association between e-cigarettes and various illnesses such as COPD, coronary heart disease, and depression.

Source:

Journal reference:

Agoons, DD, et al. (2021) Association between e-cigarette use and fragility fractures in American adults. American Journal of Medicine Open. doi.org/10.1016/j.ajmo.2021.100002.

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