There is a significant reduction in bone density of women who smoke compared with women who smoke less or not at all.

Premenopausal women smokers have normal oestrogen concentrations but increased concentrations of sex hormone binding globulins and increased 2-hydoxylation of oestradiol to 2-hydroxyoestradiol.

The most common sites to be affected by osteoporosis in smokers are the spine and the distal radius (generally regarded as being more sensitive to oestrogen).

Smokers, in general, enter menopause 1-2 years earlier than non-smokers. Smoking also is related to an increase in loss of bone density in middle-aged men compared with non-smokers.

The effect of smoking on bone loss is a dose-related.