Associations between smoke exposure and osteoporosis or osteopenia in a US NHANES population of elderly individuals

Background Tobacco exposure is considered to be a risk factor for reduced bone mineral density (BMD), which may result in osteopenia. Cotinine, a metabolite of nicotine, is commonly utilized as a marker of tobacco exposure. Nevertheless, there are limited clinical data on the associations between osteoporosis (OP) or osteopenia and smoking status or serum cotinine level. Methods We thoroughly examined the NHANES cross-sectional data from 2005 to 2010, 2013 to 2014, and 2017 to 2018. Multivariate logistic regression models were applied to assess the associations among smoking status and serum cotinine levels as well as OP and osteopenia. The relationships between serum cotinine level and OP and osteopenia were also assessed using the restricted cubic spline (RCS) method. Results A total of 10,564 participants were included in this cross-sectional study. The mean age of the study population was 64.85 ± 9.54 years, and the patients were predominantly male (51.9%). We found that the relationships between higher serum cotinine levels (≥3 ng/ml) and the prevalence of osteoporosis (Model 1: OR=2.27 1.91-2.69; Model 2: OR=2.03 1.70-2.43; Model 3: OR=2.04 1.70-2.45; all p for trend 0.001) remained significant after adjustment for covariates by applying the lowest serum cotinine levels (0.05 ng/ml) as the reference. Similar results were observed for current smokers, who were more likely to develop OP compared with nonsmokers (Model 1: OR=2.30 1.90-2.79; Model 2: OR=2.16 1.77-2.64; Model 3: OR=2.16 1.77-2.65). Moreover, higher serum cotinine levels were found to be strongly and positively correlated with the prevalence of osteopenia (OR=1.60 1.42-1.80). A similar relationship was observed between current smokers and the prevalence of osteopenia compared with nonsmokers (OR=1.70 1.49-1.94). RCS regression also showed that serum cotinine levels were nonlinearly and positively correlated with OP and osteopenia, with inflection points of 5.82 ng/ml and 3.26 ng/ml, respectively. Conclusion This study showed that being a smoker was associated with the prevalence of OP or osteopenia compared with being a nonsmoker and that there was a strong nonlinear positive dose−response relationship between serum cotinine levels and OP and osteopenia.