Abstract
BackgroundSeveral observational studies have suggested an association between cigarette smoking and risk of hip fracture. However, no formal systematic review or meta-analysis was performed to summarize this risk in men.Materials and MethodsA search was applied to MEDLINE, EMBASE, and web of science (up to November 1 2016). All prospective cohort studies assessing risk of hip fracture with the factor of cigarette smoking in men without language restriction were reviewed, and qualities of all included studies were assessed using the Newcastle-Ottawa Scale. Two authors independently assessed literatures and extracted information eligibility, and any disagreement was resolved by consensus. Newcastle-Ottawa quality assessment scale was used to evaluate studies’ quality in meta-analyses. We calculated the RR with 95% CIs in a random-effects model as well as the fixed-effects model using the metan command in the STATA version 12.0 (StataCorp, USA).ResultsFourteen prospective cohort studies were eligible for the present analysis. A meta-analysis of 12 prospective studies showed that the relative risk (RR) for current male smoking was 1.47 [95% confidence interval (CI) (1.28–1.66), p = 0.54; I2 = 0%]. Subgroup analyses show study characteristics (including geography region, length of follow-up, size of cohorts and study quality) did not substantially influence these positive associations. Eight studies reported the RRs for former smokers compared with never smokers and the pooled RR was 1.15 [95% CI, (0.97–1.34), (I2 = 0%, p = 0.975)].ConclusionsThe present meta-analysis of 14 prospective studies suggests that, compared with never smokers, cigarette smoking increases risk of hip fracture in man, specifically in current smokers. However, further larger prospective cohorts with more power or meta-analysis of individual patient data are needed to confirm this association.
Highlights
Hip fracture is a worldwide health issue, which is associated with a pronounced morbidity and excess mortality in North America and in Asia and Europe [1]
Fourteen prospective cohort studies were eligible for the present analysis
A meta-analysis of 12 prospective studies showed that the relative risk (RR) for current male smoking was 1.47 [95% confidence interval (CI) (1.28–1.66), p = 0.54; I2 = 0%]
Summary
Hip fracture is a worldwide health issue, which is associated with a pronounced morbidity and excess mortality in North America and in Asia and Europe [1]. A meta-analysis has suggested that there was a positive association between cigarette smoking and hip fracture in woman [4]. Some researches demonstrated a significant positive association between cigarette smoking and risk of hip fracture in men [3, 5,6,7], and others did not research a significant association [8,9,10,11,12], and there were still some articles did not support this relationship [13]. In 2003, a meta-analysis, including cohort, case-control, and cross-sectional studies, had estimated that smoking was associated with an increased risk of hip fracture [14]. We performed a meta-analysis using the data from published prospective cohort studies to evaluate the relationship between smoking and risk of hip fracture in male. Several observational studies have suggested an association between cigarette smoking and risk of hip fracture.
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