Young men who reported smoking at least 21 cigarettes per day or drinking heavily were up to 70% more likely to experience a fracture in middle-age when compared with nonsmokers or men who reported moderate alcohol consumption, according to findings published in the Journal of Bone and Mineral Research.
In a prospective analysis of conscript data from Sweden, researchers also observed no association between handgrip strength measured at age 18 years and fracture risk during middle-age.
“Although previous publications have consistently reported a relationship between low handgrip strength and fractures in older men, no long-term follow-up data is available to our knowledge for young adults,” Daniel Prieto-Alhambra, MD, PhD, professor of pharmaco- and device epidemiology at Botnar Research Centre in Oxford, United Kingdom, and colleagues wrote in the study background. “In parallel, evidence suggests that smoking and alcohol use could contribute to an increased fracture risk through a lower bone mineral density for smokers and a higher risk for falls and traumas for heavy alcohol drinkers.”
Prieto-Alhambra and colleagues analyzed data from 40,112 young men undergoing a conscription examination in Sweden between September 1969 and May 1970 at age 18 years. Data on muscle strength, height, weight and lifestyle factors were linked to the National Patient Register 1987-2010. Handgrip strength was considered the main exposure and smoking and alcohol consumption as secondary exposures. Outcomes were all fractures, major osteoporotic fractures and major traumatic fractures. Researchers used Cox regression models to estimate HRs according to handgrip strength as a continuous variable (per 1 standard deviation [SD]), with adjustments for weight, height, parental education, smoking and alcohol consumption.
Young men who reported smoking at least 21 cigarettes per day or drinking heavily were up to 70% more likely to experience a fracture in middle-age when compared with nonsmokers or men who reported moderate alcohol consumption.
Within the cohort, median alcohol consumption was 54 g per day, and 41% of men described themselves as nonsmokers.
Researchers found that 3,974 men experienced a fracture during middle-age, for an incidence rate of 44.5 per 1,000 person-years (95% CI, 43.2-45.9). Corresponding rates for major osteoporotic fractures and traumatic fractures were 12.2 and 5.6 per 1,000 person-years, respectively.
Researchers found no association between handgrip strength and any fracture risk.
In analyses of associations between lifestyle factors and fracture risks, researchers found that men who reported smoking at least six cigarettes per day were more likely to experience a fracture in middle-age vs. nonsmokers. The adjusted HR for smoking at least 21 cigarettes per day was 1.44 for all fractures (95% CI, 1.21-1.71).
Researchers observed a J-shaped associated between alcohol consumption and fracture risk. Compared with men who reported moderate alcohol consumption, defined as between 1 g and 100 g per week, the adjusted HR for fracture risk with no alcohol consumption was 1.23 (95% CI, 1.07-1.41), whereas the HR for consuming more than 400 g per week was 1.48 (95% CI, 1.2-1.83). The estimated population attributable fraction of fractures due to smoking and excess alcohol consumption was 11.8% (95% CI 7.9-15.5).
“About 12% of midlife fractures in men could be avoided if smoking and heavy alcohol consumption were eliminated,” the researchers wrote. – by Regina Schaffer
Disclosures: The authors report no relevant financial disclosures.