All smoking and hip fractures: [1] ”A meta-analysis


All studies chosen for this review were written and published in English language. Search was
applied to Pubmed and Cohrane data-base and included the terms: Cigarette, tobacco,
nicotine, smoking, hip fracture, fracture, current smokers, former smokers. Inclusion criteria
for this review were that the studies: a) must be published peer-reviewed articles b) published
between 1991 and 2016, c) provide a quantitative measure of bone mass by Dual X-ray
Absorptiometry (DEXA) on spine and hip or Computed Tomography, d) correlate bone mass
measurements with cigarette smoking exposure (number of cigarettes and years of smoking),
e) must include and compare patients in different smoking status and the duration of smoking
cessation, f) must report relative risks (RR) and their corresponding 95% confidence intervals
(95% CIs) of hip fracture by different smoking categories. We mainly focused on three meta-
analyses which included all the cohort studies that examined direct correlation between
smoking and hip fractures: 1 ”A meta-analysis of cigarette smoking, bone mineral
density and risk of hip fracture: recognition of a major effect” by Law MR and Hackshaw
AK. Published in 1997, 2 ”Cigarette smoking and risk of hip fracture in women: A meta-
analysis of prospective cohort studies” by a Chinese group of scientists, published in
2015 and 3 ”Effect of Cigarette Smoking on Risk of Hip Fracture in Men: A Meta-
Analysis of 14 Prospective Cohort Studies” also performed by Chinese scientists,
published in 2016. It’s important to underline that several studies are duplicated in those
meta-analyses since the researchers used common articles as sources. In order of
appearance in the reference page these studies are: 5, 6, 22, 26, 36, 38. Law and
Hackshaw 1 designed a meta-analysis of 29 published cross sectional studies reporting the
difference in bone density in 2156 smokers and 9705 non-smokers according to age, and of
19 cohort and case-control studies recording 3889 hip fractures reporting risk in smokers
relative to non-smokers. (Table1).

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