Emphysema in smokers associated with low bone mineral density and higher fracture risk: Study
A new study published in the Osteoporosis International journal revealed that emphysema, commonly seen in individuals with a history of tobacco use, is closely tied to low bone mineral density (BMD) that can lead to fractures, disability, and even death. Alarmingly, many former smokers who no longer meet the standard criteria for osteoporosis screening were found to have low BMD, highlighting a gap in current guidelines.
Osteoporosis screening is typically recommended through a dual x-ray absorptiometry (DXA) scan for older adults, postmenopausal women, and people with ongoing risk factors, like current smoking. However, former smokers, even those with chronic lung conditions like chronic obstructive pulmonary disease (COPD) or emphysema, are not currently included in standard screening recommendations. Thus, this study set out to determine whether this omission could be overlooking a high-risk population.
The study evaluated 472 adults aged 40 and older with a history of significant tobacco exposure (defined as at least 10 pack-years of cigarette smoking). Investigators used DXA scans to measure bone density at the hip, femoral neck, and lumbar spine. They also assessed whether these individuals qualified for osteoporosis screening under modified Fracture Risk Assessment Tool (FRAX) guidelines.
Among the participants, 28% did not meet existing osteoporosis screening criteria. Yet, more than half (55%) of this overlooked group were found to have low BMD when tested. This means that many former smokers who are considered “low risk” by current guidelines actually harbor a hidden vulnerability to bone loss and fractures.
The study further highlighted emphysema, identified through chest CT scans, as a strong independent predictor of low BMD. Participants with emphysema were more than twice as likely (adjusted odds ratio 2.1) to have low BMD compared to those without the condition—even after accounting for age, sex, and diabetes. Surprisingly, other factors often linked with lung health, such as reduced lung function, severity of respiratory symptoms, pack-years of smoking history, or the use of inhaled corticosteroids, showed no significant association with bone density.
Overall, these results point to a critical oversight in current health practices. While physicians routinely focus on lung function in tobacco-exposed individuals, bone health often remains under the radar. These findings suggest that emphysema should be formally recognized as a risk factor for osteoporosis, warranting earlier and broader use of DXA scans in former smokers.
Source:
Du, X., Nouraie, S. M., Pu, J., Karoleski, C., Sciurba, F. C., Greenspan, S. L., & Bon, J. (2025). Lung-related risk factors associate with low bone mineral density in individuals with former tobacco exposure not meeting osteoporosis screening criteria. Osteoporosis International: A Journal Established as Result of Cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA. https://doi.org/10.1007/s00198-025-07648-1
