Association between electronic cigarette use and fragility fractures among US adults.

Background: The popularity of electronic cigarette (e-cigarette) use continues to rise in the United States. While conventional cigarette smoking is an established risk factor for osteoporosis and osteoporotic fracture, the effects of e-cigarette use on bone health are unknown. We aimed to examine the association between e-cigarette use and fragility fractures. Research Design and Methods: We pooled 2017-2018 data from the National Health and Nutrition Examination Survey (NHANES). We included men and women with complete information on key variables. E-cigarette use was categorized as either never or ever users. Ever users were further classified as former and current users. Fragility fracture was defined as a composite of self-reported fracture of the hip, spine or wrist which resulted from minimal trauma such as a fall from standing height or less. Results: Of 5569 participants, there were 4519 (81.2%) never e-cigarette users, 1050 (18.8%) ever e-cigarette users, and 444 (8.0%) with self-reported fragility fracture. In adjusted models, ever e-cigarette users had a 46% higher prevalence of self-reported fragility fractures compared to never users (aPR: 1.46, 95% CI: 1.12, 1.89). We also observed a higher prevalence of fragility fractures among former and current e-cigarette users compared to never users (aPR: 1.89, 95% CI: 1.44, 2.48 and aPR: 1.77, 95% CI: 1.04, 3.02 respectively). Conclusion: E-cigarette use was associated with a higher prevalence of self-reported fragility fracture. These findings suggest that e-cigarette use may be harmful to bone health. These data highlight the critical need for longitudinal studies exploring the potential effect(s) of e-cigarette use on bone health.