title: Bone density loss on computed tomography at 3-year follow-up in current compared to former male smokers.
abstract: OBJECTIVE
  Cigarette smoking negatively affects bone quality and increases fracture risk. Little is known on the effect of smoking cessation and computed tomography (CT)-derived bone mineral density (BMD) decline in the spine. We evaluated the association of current and former smoking with BMD decline after 3-year follow-up.
  
  
  METHODS
  Male current and former smokers participating in a lung cancer screening trial who underwent baseline and 3-year follow-up CT were included. BMD was measured by manual placement of a region of interest in the first lumbar vertebra and expressed in Hounsfield Unit (HU). Multiple linear regression analysis was used to evaluate the association between pack years smoked and smoking status with BMD decline.
  
  
  RESULTS
  408 participants were included with median (25th-75th percentile) age of 59.4 (55.9-63.5) years. At the start of the study, 197 (48.3%) participants were current smokers and 211 (51.7%) were former smokers and had a similar amount of pack years. Current smokers had quit smoking for 6 (4-8) years prior to inclusion. There was no difference in BMD between current and former smokers at baseline (109±34 HU vs. 108±32 HU, p=0.96). At 3-year follow-up, current smokers had a mean BMD decline of -3±13 HU (p=0.001), while BMD in former smokers did not change as compared to baseline (1±13 HU, p=0.34). After adjustment for BMD at baseline and body mass index, current smoking was independently associated with BMD decline (-3.8 HU, p=0.003). Age, pack years, and the presence of a fracture at baseline did not associate with BMD decline.
  
  
  CONCLUSIONS
  Current smokers showed a more rapid BMD decline over a 3-year period compared to former smokers. This information might be important to identify subjects at risk for osteoporosis and emphasizes the importance of smoking cessation in light of BMD decline.
authors.affiliation: Department of Pulmonology, University Medical Center Utrecht, Utrecht, The Netherlands. Electronic address: e.pompe@umcutrecht.nl.
authors.forename: E
authors.initials: E
authors.lastname: Pompe
authors.affiliation: Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: J
authors.initials: J
authors.lastname: Bartstra
authors.affiliation: Department of Geriatric Medicine, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: H J
authors.initials: HJ
authors.lastname: Verhaar
authors.affiliation: Department of Public Health, Erasmus MC - University Medical Center Rotterdam, Rotterdam, The Netherlands.
authors.forename: H J
authors.initials: HJ
authors.lastname: de Koning
authors.affiliation: Department of Public Health, Erasmus MC - University Medical Center Rotterdam, Rotterdam, The Netherlands.
authors.forename: C M
authors.initials: CM
authors.lastname: van der Aalst
authors.affiliation: University of Groningen, University Medical Center Groningen, Groningen, Department of Radiology, The Netherlands.
authors.forename: M
authors.initials: M
authors.lastname: Oudkerk
authors.affiliation: University of Groningen, University Medical Center Groningen, Groningen, Department of Radiology, The Netherlands; University of Groningen, University Medical Center Groningen, Center for Medical Imaging-North East Netherlands, Groningen, The Netherlands.
authors.forename: R
authors.initials: R
authors.lastname: Vliegenthart
authors.affiliation: Department of Pulmonology, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: J-W J
authors.initials: JJ
authors.lastname: Lammers
authors.affiliation: Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: P A
authors.initials: PA
authors.lastname: de Jong
authors.affiliation: Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: F A A
authors.initials: FAA
authors.lastname: Mohamed Hoesein
mesh_terms: D015502:Absorptiometry, Photon / Q000379:methods; D000368:Aged; D015519:Bone Density / Q000502:physiology; D055088:Early Detection of Cancer / Q000379:methods; D005500:Follow-Up Studies; D006801:Humans; D008159:Lumbar Vertebrae; D008175:Lung Neoplasms / Q000175:diagnosis / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D010024:Osteoporosis / Q000000981:diagnostic imaging* / Q000209:etiology / Q000503:physiopathology; D058866:Osteoporotic Fractures / Q000000981:diagnostic imaging / Q000209:etiology / Q000503:physiopathology; D012907:Smoking / Q000009:adverse effects*; D014057:Tomography, X-Ray Computed / Q000379:methods
keywords: Bone mineral density; Cigarette smoking; Computed tomography; Osteoporosis; Screening