In addition to lung disease, cancer and heart disease, cigarette smoking may also increase the risk of serious back problems.

A review of the data available on smokers found that they are more likely than nonsmokers to have back problems such as pain, sciatica and degenerative disease of the spine. In a study published in the July issue of the journal Neurosurgery, two researchers reported that smokers were four times more likely than nonsmokers to require spinal fusion surgery, particularly for low-back problems. Compared with nonsmokers, the time to heal from the surgery was much slower for smokers and more likely to be fraught with complications. Dr. Mark N. Hadley of the University of Alabama at Birmingham, and Dr. Sadda V. Reddy of Valley Medical Center in Fresno, California, concluded that chronic tobacco use leads to a weakening of the bones and a slowing down of the production of new, healthy bone cells. These bone changes put people at risk for a number of back problems by causing an overall weakening of the vertebra (spinal column). Smoking may weaken bones by reducing the blood supply to the bone, by making the chemical environment around the bone more acidic, or by interfering with the activity of bone-forming cells called osteoblasts, the researchers wrote. Although nicotine is a likely culprit, Hadley and Reddy said the thousands of break-down products found in tobacco smoke may also play an important role in contributing to weak bones. Studies have shown that smoking reduces the bone mineral content of individual vertebrae, which causes them to become brittle and weak. Women are at particularly high risk of thinning bones after menopause because of reduced levels of bone-strengthening estrogen in their bodies. Postmenopausal women who smoke would appear to be at highest risk if they do not take estrogen-replacement therapy or stop smoking. Weak and brittle bones break easier than healthy bones and do not heal as fast. But the good news, according to the researchers, is that the rate of bone-loss slows down when people stop smoking.

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