Meta-analysis of cigarette smoking, bone mineral density, and risk of hip fracture

BMJ 1998; 316 doi: https://doi.org/10.1136/bmj.316.7136.1017 (Published 28 March 1998) Cite this as: BMJ 1998;316:1017

Three studies were omitted from meta-analysis

  1. David J Torgerson, Senior research fellow,
  2. David M Reid, Reader in rheumatology,
  3. Marion K Campbell, Senior statistician
  1. Centre for Health Economics, University of York, York YO1 5DD
  2. Department of Medicine and Therapeutics, University of Aberdeen, Aberdeen AB25 2ZD
  3. Health Services Research Unit, University of Aberdeen
  4. Wolfson Institute of Preventive Medicine, St Bartholomew's and the Royal London School of Medicine, London EC1M 6BQ

    EDITOR—Law and Hacksaw's meta-analysis of cigarette smoking, bone mineral density, and risk of hip fracture seems to be incomplete.1 At least three relevant studies,24 including our own,4 were not included. One of these studies,3 however, would need reanalysis of the data. In our study a random sample of 1227 premenopausal women aged 45-49 (including 311 smokers) had their bone mineral density measured with dual energy x ray absorptiometry, and several risk factors were then related to bone mineral density. This study was more than three times bigger than the largest study of premenopausal women included in the meta-analysis. Although smoking was significantly associated with low bone mineral density at all sites, this difference was abolished after adjustment for current body weight. There was, however, a suggestion of a link between low bone mineral density and smoking during pregnancy.4

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