BMJ 1994; 308 doi: https://doi.org/10.1136/bmj.308.6927.546 (Published 19 February 1994) Cite this as: BMJ 1994;308:546

Women who smoke one pack of 20 cigarettes each day throughout their adult lives will have a 5-10% deficit in bone density at the menopause (New England Journal of Medicine 1994;330:387-92). These data, from a study of twins discordant for smoking, add to the evidence that smoking roughly doubles a woman's chance of having a fracture in later life. Furthermore, oestrogen seems to give less protection against osteoporosis in smokers than in non -smokers.

In the mid-1980s nephrologists believed that treatment with erythropoietin would correct the anaemia of renal failure, eliminate the need for transfusion, and improve patients' quality of life. In practice, says a review in “Kidney International” (1994;45(suppl 44):S70-6), most treated patients remain anaemic with haemoglobin concentrations of 85 to 110 g/l, transfusions are still needed, and changes in the quality of life have been disappointing. The explanation? Undertreatment - because of cost and fears of side effects.

Since 1973 mortality from cardiovascular disease has fallen by 33% in white men and women aged 55-84 in the United States (JAMA 1994;271:431-7). In the same period mortality from cancer rose by 12%. Clearly, …

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