Abstract
This systematic review explored associations between smoking and health outcomes involving the musculoskeletal system. AMSTAR criteria were followed. A comprehensive search of PubMed, Web of Science, and Science Direct returned 243 articles meeting inclusion criteria. A majority of studies found smoking has negative effects on the musculoskeletal system. In research on bones, smoking was associated with lower BMD, increased fracture risk, periodontitis, alveolar bone loss, and dental implant failure. In research on joints, smoking was associated with increased joint disease activity, poor functional outcomes, and poor therapeutic response. There was also evidence of adverse effects on muscles, tendons, cartilage, and ligaments. There were few studies on the musculoskeletal health outcomes of secondhand smoke, smoking cessation, or other modes of smoking, such as waterpipes or electronic cigarettes. This review found evidence that suggests tobacco smoking has negative effects on the health outcomes of the musculoskeletal system. There is a need for further research to understand mechanisms of action for the effects of smoking on the musculoskeletal system and to increase awareness of healthcare providers and community members of the adverse effects of smoking on the musculoskeletal system.
Highlights
Tobacco smoke has more than 7,000 harmful chemical compounds that enter a human body either directly through smoking, indirectly through secondhand exposure to smoke exhaled by a smoker, or through downstream smoke released from a cigarette or pipe [1]
Two cohort studies investigated the risks for joint surgery: one prospective cohort study reported smoking increased the risk for total joint replacement (TJR) in males [186]; conflicting evidence was reported by another retrospective cohort study that found an inverse association between smoking and TJR, but this study investigated the risk for only primary TJR and included both sexes [187]
Evidence found smoking associated with lower bone mineral density (BMD), and increased risk for fracture, periodontitis, alveolar bone loss and implant failure, increased joint disease, poor functional outcomes, and poor therapeutic response
Summary
Tobacco smoke has more than 7,000 harmful chemical compounds that enter a human body either directly through smoking, indirectly through secondhand exposure to smoke exhaled by a smoker, or through downstream smoke released from a cigarette or pipe [1]. Both smokers and nonsmokers are at risk of exposure to the compounds of smoked tobacco that accumulate on the surfaces in a poorly ventilated environment; this method of exposure is known as thirdhand smoke exposure [2]. Tobacco smoking has known adverse consequences on most human body systems. According to the recent Surgeon General report, the causal relationship between tobacco smoking and rheumatoid arthritis, periodontitis, and hip fractures has been confirmed [3]; there is inconclusive evidence to support causality between smoking and many other musculoskeletal disorders
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