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Health Column

Let’s talk tobacco: Effects on bone and joint health

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Colin Looney

Colin Looney, M.D., is an orthopaedic surgeon at Bone and Joint Institute of Tennessee.

More than 16 million Americans are currently living with a disease caused by smoking, which is the leading cause of preventable death. Smoking-related diseases can harm nearly every organ in the body, causing cancer, heart disease, stroke, lung disease and much more. What many people may not know is that tobacco use can affect smokers all the way down to their bones.  

Each year, the American Cancer Society observes the Great American Smokeout on the third Thursday in November with a goal to encourage people to stop smoking.  

As an orthopaedic surgeon at Bone and Joint Institute of Tennessee, I take care of a broad range of musculoskeletal problems. As we observe the Great American Smokeout this year, I feel it’s important to shed light on the many negative impacts smoking has on your muscles and bones.  

Tobacco use contributes to a wealth of musculoskeletal problems.  

Tobacco has a huge impact on bone mineralization, which puts users at risk of developing osteoporosis and leads to fragility fractures. In the older population, fractures can be life-threatening. Unfortunately, tobacco use also affects the ability for broken bones to heal properly.  

Osteonecrosis, or bone death, can also be caused by tobacco use. When this occurs, orthopaedic surgery such as a hip or knee replacement might be recommended.  

Tobacco use can lead to surgery complications. 

Much of my week is spent in the operating room. If I perform the same procedure on two patients, one a tobacco user and one not, the tobacco user is twice as unlikely to heal. Tobacco use increases the risk of infection and has a huge effect on small vessels, which leads to poor healing. Due to this, the patients who smoke have a higher mortality rate than those who do not.  

All forms of tobacco — including smokeless and chewing tobacco — have negative implications.  

Tobacco use in any form is a bad idea. The new trend of smokeless tobacco or vaping has not been adequately studied in relation to musculoskeletal health. What we do know is that smokeless tobacco and cigarettes are loaded with preservatives, including heavy metals, that are very bad for the human body. Heavy metals settle in bones, mimicking symptoms of lead poisoning.  

It’s never too late to quit.  

Once patients quit using tobacco, the positive effects are almost immediate. Ceasing tobacco use can actually ease pain, increase energy and greatly improve overall health. Unrelated to musculoskeletal health, tobacco cessation also increases longevity of life, decreases the risk of heart disease and lowers the risk of developing cancer.  

There are resources available to help you get started.  

It’s one thing to tell patients they have to stop smoking, and another to tell them we’re on this journey together. When I see a patient who needs surgery or is experiencing tobacco-related problems, I am happy to provide smoking cessation resources and work directly with a primary care provider to ensure we have a plan in place.  

One of the best resources available to help cease smoking is exercise. Smoking triggers the dopamine reward system, an addictive chemical in your brain. That system can also be tapped into by exercise, so I always encourage a 10-minute walk first thing in the morning. If you get up and walk, it makes you not want to smoke. If you get up and smoke, it makes you not want to walk.  

Free counseling services are available by calling 1-800-QUIT-NOW. Spanish-speaking counselors are available at 1-877-44U-QUIT. For additional resources, visit

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