Topics

Intro
Cigarette Smoke
Nicotine
Carbon Monoxide
Other Substances
Smoke and Bone
Bone Healing
Wound Healing
Osteonecrosis
Lower Back Pain
Arthritis
Dupuytrens
RSD (CRPS)
Summary
Bibliography

Summary

Chronic smoking has many consequences, many of which are directed to the musculoskeletal system. Nicotine alone causes vascular constriction, increased platelet adhesiveness, and increased fibrogen levels. At the cellular level, it is toxic to the osteoblast, macrophage and fibroblast. The effects of nicotine are compounded by carbon monoxide which interferes with oxygen transport and further increases blood viscosity, and hydrogen cyanide which interferes with oxidative metabolism. Other substances in tobacco smoke may have additional unrecognized consequences upon smokers and nonsmokers alike.

Smoking is emerging as a powerful risk factor for the development of osteoporosis in women as well as men. Cigarette use leads to the skeletal fragility, and when injury occurs, it also interferes with wound and bone healing. In addition, cigarette smoking represents a risk factor for the development of rheumatoid arthritis, disc degeneration, back pain and pain in general. Due to hemodynamic effects in the upper extremity, tobacco places smokers at increased risk for the development of Dupuytren's Contracture, and reflex sympathetic dystrophy. Similar effects in the hip place the smoker at higher risk for the development of osteonecrosis. Although smoking may have a protective effect for the development of osteoarthritis, the risks of smoking far outweigh any possible benefit.

Cigarette smoking is probably the greatest potentially reversible risk factor in the area of public health, and unlike many risk factors, is totally under individual control.