Evidence map›Paper›PMID 41779026›Full record

SynthesisOsteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA2026

A meta-analysis of smoking and fracture risk to update the FRAX® tool.

Marian Schini, Helena Johansson, Nicholas C Harvey, Mattias Lorentzon, Enwu Liu, Liesbeth Vandenput, William D Leslie, Kristina E Åkesson, Fred A Anderson, Rafael Azagra-Ledesma and 78 more

Abstract readMeta-AnalysisReview
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In one paragraph

Synthesis in Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.

0numbers the graph read from it
0cells of the map it votes in
2citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

2 citing papers in PubMed.

  1. Article
  2. Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

88 authors.

Marian SchiniMellanby Centre for Musculoskeletal Research, Division of Clinical Medicine, School of Medicine & Population Health, University of Sheffield, Sheffield, UK.
Helena JohanssonCentre for Metabolic Bone Diseases, University of Sheffield, Sheffield, UK.
Nicholas C HarveyMRC Lifecourse Epidemiology Centre, University of Southampton, Southampton, UK.
Mattias LorentzonSahlgrenska Osteoporosis Centre, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden.
Enwu LiuCollege of Medicine and Public Health. , Flinders University, Adelaide, Australia.
Liesbeth VandenputSahlgrenska Osteoporosis Centre, Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
William D LeslieDepartment of Medicine, University of Manitoba, Winnipeg, MB, Canada.ORCID http://orcid.org/0000-0002-1056-1691
Kristina E ÅkessonClinical and Molecular Osteoporosis Research Unit, Department of Clinical Sciences, Lund University, Lund, Sweden.
Fred A AndersonGLOW Coordinating Center, Center for Outcomes Research, University of Massachusetts Medical School, Worcester, MA, USA.
Rafael Azagra-LedesmaDepartment of Medicine, Autonomous University of Barcelona, Barcelona, Spain.ORCID http://orcid.org/0000-0003-0093-333X
Cecilie L BagerNordic Bioscience A/S, Herlev, Denmark.
Charlotte BeaudartPublic Health Aging Research & Epidemiology (PHARE) Group, Research Unit in Clinical Pharmacology and Toxicology (URPC), NAmur Research Institute for LIfe Sciences (NARILIS), University of Namur, Namur, Belgium.ORCID http://orcid.org/0000-0002-0827-5303
Heike A Bischoff-FerrariDepartment of Aging Medicine, FELIX PLATTER, University of Basel, Basel, Switzerland.
Emmanuel BiverDivision of Bone Diseases, Department of Medicine, Geneva University Hospitals and, Faculty of Medicine, University of Geneva, Geneva, Switzerland.ORCID http://orcid.org/0000-0001-6174-1951
Olivier BruyèreResearch Unit in Public Health, Epidemiology and Health Economics, University of Liège, Liège, Belgium.ORCID http://orcid.org/0000-0003-4269-9393
Jane A CauleyDepartment of Epidemiology, School of Public Health, University of Pittsburgh, Pittsburgh, Philadelphia, USA.ORCID http://orcid.org/0000-0003-0752-4408
Jacqueline R CenterSkeletal Diseases Program, Garvan Institute of Medical Research, Sydney, NSW, Australia.ORCID http://orcid.org/0000-0002-5278-4527
Roland ChapurlatINSERM UMR 1033, Université Claude Bernard-Lyon1, Hôpital Edouard Herriot, Lyon, France.
Claus ChristiansenNordic Bioscience A/S, Herlev, Denmark.
Cyrus CooperMRC Lifecourse Epidemiology Centre, University of Southampton, Southampton, UK.
Carolyn J CrandallDivision of General Internal Medicine and Health Services Research, David Geffen School of Medicine, University of California, Los Angeles, CA, USA.
Steven R CummingsSan Francisco Coordinating Center, California Pacific Medical Center Research Institute, San Francisco, CA, USA.
José A P da SilvaCoimbra Institute for Clinical and Biomedical Research, Faculty of Medicine, University of Coimbra, Coimbra, Portugal.ORCID http://orcid.org/0000-0002-2782-6780
Bess Dawson-HughesBone Metabolism Laboratory, Jean Mayer US Department of Agriculture Human Nutrition Research Center On Aging, Tufts University, Boston, MA, USA.ORCID http://orcid.org/0000-0003-3136-0386
Adolfo Diez-PerezDepartment of Internal Medicine, Hospital del Mar and CIBERFES, Autonomous University of Barcelona, Barcelona, Spain.
Alyssa B DufourMarcus Institute for Aging Research, Hebrew SeniorLife, Boston, MA, USA.
John A EismanSkeletal Diseases Program, Garvan Institute of Medical Research, Sydney, NSW, Australia.ORCID http://orcid.org/0000-0002-7162-7471
Petra J M EldersDepartment of General Practice, Amsterdam, UMC, Location AMC , Amsterdam Public Health Research Institute, Amsterdam, The Netherlands.
Serge FerrariDivision of Bone Diseases, Department of Medicine, Geneva University Hospitals and, Faculty of Medicine, University of Geneva, Geneva, Switzerland.
Yuki FujitaDepartment of Hygiene and Public Health, Faculty of Medicine, Kansai Medical University, Osaka, Japan.ORCID http://orcid.org/0000-0002-7490-258X
Saeko FujiwaraDepartment of Pharmacy, Yasuda Women's University, Hiroshima, Japan.
Claus-Christian GlüerSection Biomedical Imaging, Molecular Imaging North Competence Center, Department of Radiology and Neuroradiology, University Medical Center Schleswig-Holstein Kiel, Kiel University, Kiel, Germany.
Inbal GoldshteinMaccabitech Institute of Research and Innovation, Maccabi Healthcare Services, Tel Aviv, Israel.ORCID http://orcid.org/0000-0002-5317-2848
David GoltzmanDepartment of Medicine, McGill Universityand, McGill University Health Centre , Montreal, Canada.
Vilmundur GudnasonIcelandic Heart Association, Kopavogur, Iceland.
Jill HallMRC Centre for Reproductive Health, University of Edinburgh, Edinburgh, UK.
Didier HansCentre of Bone Diseases, Bone and Joint Department, Lausanne University Hospital, Lausanne, Switzerland.ORCID http://orcid.org/0000-0003-1826-5958
Mari HoffDepartment of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Trondheim, Norway.ORCID http://orcid.org/0000-0002-9992-8663
Rosemary J HollickAberdeen Centre for Arthritis and Musculoskeletal Health, Epidemiology Group, University of Aberdeen, Aberdeen, UK.
Martijn HuismanDepartment of Epidemiology and Data Science, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.ORCID http://orcid.org/0000-0002-9285-6759
Masayuki IkiDepartment of Public Health, Kindai University Faculty of Medicine, Osaka, Japan.ORCID http://orcid.org/0000-0003-2128-5255
Sophia Ish-ShalomEndocrine Clinic, Elisha Hospital, Haifa, Israel.
Graeme JonesMenzies Institute for Medical Research, University of Tasmania, Hobart, Australia.
Magnus K KarlssonClinical and Molecular Osteoporosis Research Unit, Department of Clinical Sciences, Lund University, Lund, Sweden.ORCID http://orcid.org/0000-0002-0616-5928
Sundeep KhoslaRobert and Arlene Kogod Center On Aging and Division of Endocrinology, Mayo Clinic College of Medicine, Mayo Clinic, Rochester, MN, USA.
Douglas P KielMarcus Institute for Aging Research, Hebrew SeniorLife, Boston, MA, USA.
Woon-Puay KohHealthy Longevity Translational Research Programme, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.ORCID http://orcid.org/0000-0002-5674-6341
Fjorda KoromaniDepartment of Internal Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands.
Mark A KotowiczIMPACT (Institute for Mental and Physical Health and Clinical Translation), Deakin University, Geelong, VIC, Australia.ORCID http://orcid.org/0000-0002-8094-1411
Heikki KrögerDepartment of Orthopedics and Traumatology, Kuopio University Hospital, Kuopio, Finland.ORCID http://orcid.org/0000-0003-4245-8186
Timothy KwokDepartment of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, , China.ORCID http://orcid.org/0000-0001-9253-3549
Olivier LamyCentre of Bone Diseases, Lausanne University Hospital, Lausanne, Switzerland.
Arnulf LanghammerHUNT Research Centre, Department of Public Health and Nursing, NTNU, Norwegian University of Science and Technology, Levanger, Norway.ORCID http://orcid.org/0000-0001-5296-6673
Bagher LarijaniEndocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran.ORCID http://orcid.org/0009-0007-9526-9430
Kurt LippunerARTORG Center for Biomedical Engineering Research, Faculty of Medicine, University of Bern, Bern, Switzerland.
Fiona E A McGuiganClinical and Molecular Osteoporosis Research Unit, Department of Clinical Sciences, Lund University, Lund, Sweden.
Dan MellströmGeriatric Medicine, Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
Thomas MerlijnDepartment of General Practice, Amsterdam, UMC, Location AMC , Amsterdam Public Health Research Institute, Amsterdam, The Netherlands.
Tuan V NguyenSchool of Biomedical Engineering, University of Technology Sydney, Sydney, Australia.ORCID http://orcid.org/0000-0002-3246-6281
Anna NordströmDepartment of Medical Sciences, Uppsala University, Uppsala, Sweden.ORCID http://orcid.org/0000-0003-3534-456X
Peter NordströmDepartment of Public Health and Caring Sciences, Clinical Geriatrics, Uppsala University, Uppsala, Sweden.ORCID http://orcid.org/0000-0003-2924-508X
Barbara Obermayer-PietschDepartment of Internal Medicine, Division of Endocrinology and Diabetology, Medical University Graz, Graz, Austria.ORCID http://orcid.org/0000-0003-3543-1807
Claes OhlssonSahlgrenska Osteoporosis Centre, Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
Terence W O'NeillNIHR Manchester Biomedical Research Centre, Manchester University Foundation NHS Trust, Manchester, UK.ORCID http://orcid.org/0000-0002-8896-4677
Eric S OrwollDepartment of Medicine, Oregon Health and Science University, Portland, OR, USA.ORCID http://orcid.org/0000-0002-8520-7355
Julie A PascoInstitute for Physical and Mental Health and Clinical Translation (IMPACT), Deakin University, Geelong, Australia.ORCID http://orcid.org/0000-0002-8968-4714
Fernando RivadeneiraDepartment of Internal Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands.
Berit ScheiDepartment of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway.
Anne-Marie SchottUniversité Claude Bernard Lyon 1, U INSERM 1290 RESHAPE, Lyon, France.ORCID http://orcid.org/0000-0003-3337-4474
Eric J ShiromaLaboratory of Epidemiology and Population Sciences, National Institute On Aging, Baltimore, MD, USA.
Kristin SiggeirsdottirIcelandic Heart Association, Kopavogur, Iceland.ORCID http://orcid.org/0000-0002-4643-8732
Eleanor M SimonsickTranslational Gerontology Branch, National Institute On Aging Intramural Research Program, Baltimore, MD, USA.ORCID http://orcid.org/0000-0002-5460-3494
Elisabeth Sornay-RenduINSERM UMR 1033, University of Lyon, Hôpital Edouard Herriot, Lyon, France.
Reijo SundKuopio Musculoskeletal Research Unit, University of Eastern Finland, Kuopio, Finland.ORCID http://orcid.org/0000-0002-6268-8117
Karin Ma SwartDepartment of General Practice, Amsterdam, UMC, Location VUmc , Amsterdam Public Health Research Institute, Amsterdam, The Netherlands.
Pawel SzulcINSERM UMR 1033, University of Lyon, Hôpital Edouard Herriot, Lyon, France.ORCID http://orcid.org/0000-0003-4168-6697
Junko TamakiDepartment of Hygiene and Public Health, Faculty of Medicine, Educational Foundation of Osaka Medical and Pharmaceutical University, Osaka, Japan.
David J TorgersonYork Trials Unit, Department of Health Sciences, University of York, York, UK.
Natasja M van SchoorDepartment of Epidemiology and Data Science, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.ORCID http://orcid.org/0000-0002-0870-0795
Tjeerd P van StaaCentre for Health Informatics, Faculty of Biology, Medicine and Health, School of Health Sciences, University of Manchester, Manchester, UK.ORCID http://orcid.org/0000-0001-9363-742X
Joan VilaStatistics Support Unit, Hospital del Mar Medical Research Institute, CIBER Epidemiology and Public Health (CIBERESP), Barcelona, Spain.
Nicholas J WarehamMRC Epidemiology Unit, University of Cambridge, Cambridge, UK.
Nicole C WrightCenter for Health Outcomes, Implementation, Community-Engaged Sciences, School of Medicine, Tulane University, New Orleans, LA, USA.ORCID http://orcid.org/0000-0001-8414-4842
Noriko YoshimuraDepartment of Preventive Medicine for Locomotive Organ Disorders, 22, Century Medical and Research Center, The University of Tokyo, Tokyo, Japan.ORCID http://orcid.org/0000-0001-9206-4658
MCarola ZillikensDepartment of Internal Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands.ORCID http://orcid.org/0000-0001-9186-3423
Marta ZwartHealth Center Can Gibert del Plà, Catalan Institute of Health, Girona, Spain.ORCID http://orcid.org/0000-0003-4888-0927
John A KanisCentre for Metabolic Bone Diseases, University of Sheffield, Sheffield, UK.
Eugene V McCloskeyMellanby Centre for Musculoskeletal Research, Division of Clinical Medicine, School of Medicine & Population Health, University of Sheffield, Sheffield, UK. e.v.mccloskey@sheffield.ac.uk.ORCID http://orcid.org/0000-0003-0177-8140

Funding

Oregon Clinical and Translational Research InstituteUL1TR000128 · NCATS · OREGON HEALTH & SCIENCE UNIVERSITY · PI ELLISON, DAVID H · 2012 to 2015
$28.7M
Osteoporotic Fractures in Men (MrOS) - MinneapolisU01AG042145 · NIA · UNIVERSITY OF MINNESOTA · PI ENSRUD, KRISTINE · 2013 to 2019
$5.3M
NCATS NIH HHS UL1 TR000128NIA NIH HHS U01 AG042145
6 · The paper itself

Abstract

In this meta-analysis of international cohorts, current smoking is confirmed as a significant BMD-independent predictor of future fracture with a stronger relationship in men than in women. A causative and reversible effect of smoking on fracture risk is suggested by past smoking having a significantly lower risk than current smoking. PURPOSE: In this meta-analysis of international cohorts, the aim was to examine the relationship of current and past smoking with fracture risk to provide an update for future iterations of the FRAX tool.

methodsThe risk of fracture associated with current and past smoking was estimated using an extended Poisson model applied separately to each of 58 prospective international cohort studies. Covariates included current time since start of follow up, current age, and in an additional model, BMD at the femoral neck. The results of the different studies were merged by using inverse-variance weighted β-coefficients.

resultsThis analysis included a total of 1,691,024 participants (61.2% women, overall mean age 58.8 years). Current smoking, documented in 12.1% of all participants (15.2% and 10.1% respectively in men and women), was associated with a significantly increased risk of any clinical fracture, osteoporotic fracture, major osteoporotic fracture, and particularly hip fracture in both sexes. The hazard ratio (HR) for fracture was greater in men than in women for all fracture categories [e.g. hip fracture HR (95% confidence interval): 1.78 (1.58-2.00) vs. 1.64 (1.50-1.78)]. Low BMD explained about 19-54% of the increase in risk. When compared with never smoking, past smoking was associated with a significantly lower risk than current smoking [e.g. hip fractures for men, HR in past smokers: 1.08 (1.05-1.12) vs. 1.73, 95%CI (1.46-2.05) in current smokers].

conclusionsOur results confirm the association between current smoking and increased fracture risk that is partly independent of BMD; these data will be used to inform future iterations of FRAX.

Indexed as

Osteoporotic FracturesSmokingBone DensityFemaleFemur NeckHip FracturesHumansMaleMiddle AgedRisk AssessmentBone mineral densityEpidemiologyFractureFRAXOsteoporosisSmoking

Identifiers

PMID41779026

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.