Smoking Hurts Bones

Cigarettes can delay bone healing and fracture repair

Man Smoking in Public Space. Credit: Universal Images Group / Getty Images

Did you know that smoking can mean it takes months longer to heal a broken bone, and may lead to other bone healing complications? If you smoke and you need orthopedic surgery, it would be wise to quit two months in advance to improve your recovery, and this will likely be recommended by your doctor.

Smoking cigarettes has long been known to have detrimental effects on the body, contributing to problems such as heart disease and lung cancer.

Research has also shown that smoking cigarettes has significant effects on the bones that make up your skeleton.

What evidence shows these effects of smoking on the bone?

Multiple studies have shown a significant difference in the healing time of bone between groups of smokers and non-smokers. For example, a study looked at patients who were surgically treated for a specific wrist injury. Of these patients, 95% of the non-smokers healed completely, while only 68% of the smokers healed completely. The average time until complete healing was over 2 months longer in the smokers. Numerous other studies on patients with different injuries have shown a similar effect.

Rotator cuff repair after a shoulder injury is a common surgery. A review of studies found that smokers had impaired healing of rotator cuff tears, worse quality of repair and decreased biomechanics, with overall poorer clinical outcomes.

Broken shin bones - tibia fractures - were studied in a large review that concluded that smoking reduced bone healing in this common type of fracture. Ex-smokers also had a longer healing time, but their risk was not as great as current smokers.

Why are bones affected by smoking?

Bones are nourished by blood much like the other organs and tissues in your body.

Nutrients, minerals, and oxygen are all supplied to the bones via the blood stream. Smoking elevates the levels of nicotine in your blood and this causes the blood vessels to constrict. Nicotine constricts blood vessels approximately 25% of their normal diameter. Because of the constriction of the vessels, decreased levels of nutrients are supplied to the bones. It is thought that this is the reason for the effect on bone healing.

What does all this mean?

The effect of smoking on your health is well known to have a significant negative impact. While the effect of bone healing may not seem as important as other effects, ask anyone who is waiting for their skeleton to mend and they will tell you how important bone health can be.

If you sustain an injury to your bone, including any type of fracture, it is of utmost importance that you do not smoke. Doing so will decrease your chances of recovering completely, lengthen the time you spend healing, and make it less likely that you will be satisfied with your outcome.

If you are going to have orthopedic surgery, your doctor is likely to recommend quitting smoking weeks to months in advance. If you can be an ex-smoker by the time you have surgery and you don't smoke during recovery, it may improve your healing time and surgical success.


Chen F, "Smoking and bony union after ulna-shortening osteotomy" Am J Orthop. 2001 Jun;30(6):486-9.

Chen F, et al. "Smoking and bony union after ulna-shortening osteotomy" Am J Orthop (Belle Mead NJ). 2001 Jun;30(6):486-9.

Santiago-Torres J, Flanigan DC, Butler RB, Bishop JY. "The effect of smoking on rotator cuff and glenoid labrum surgery: a systematic review." Am J Sports Med. 2015 Mar;43(3):745-51. doi: 10.1177/0363546514533776. Epub 2014 May 23.

R. A. Patel, BDS., et. al. "The effect of smoking on bone healing. A systematic review." Bone Joint Res. 2013 Jun; 2(6): 102–111. Published online 2013 Jun 1. doi: 10.1302/2046-3758.26.2000142.

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