Fertility Disorders Urinary Tract Diseases
7.7 Disorders of Mineral Metabolism and Bone
Forseveralyears,anassociationhasbeensuspectedbetweensmokinganddisordersof mineralmetabolism,andstudieshaverecentlybeenpublishedwhichdemonstrateasignii- canteffectofdecadesofsmokingoncalciummetabolismandhenceonbonedensity.In thiscontext,thekeyhormonesare25-hydroxyvitaminD25-OH-Dandparathyroidhor- monePTH [438–443] .Adrenocortical,anteriorpituitaryandthyroidhormonesarealso adverselyaffected [444–446] . Clinical studies in recent years have focussed on the harmful effects of smoking in women.Investigationsinratsindicatethatnicotinehasnoadverseconsequencesintermsof bonemineraldensityorfracturetendency [447] .Whenratsweretreatedwithextremely high-dosenicotineinfusions2.5-foldhigherconcentrationsthantheaverageinsmokers, nochangeswereproducedinserumconcentrationsofcalcium,25-OH-Dand1,25-dihy- droxyvitaminD1,25-OH 2 -D;however,serumphosphorusandPTHconcentrationswere increased [448] . It is further conceivable that various tobacco smoke constituents, such ascadmium,hydroquinone,thiocyanateandnitrosamines,exertaninluenceoncalcium metabolism [449–451] .7.7.1 Vitamin D and Oestrogen Metabolism
Smoking causes reductions in 25-OH-D, osteocalcin [452] and PTH which cannot be explainedintermsofotherlifestylefactors [453] .ThedeclineinPTHlevelsisevidently 80 70 60 50 40 30 20 10 AI SV SZ TSZ MS TMS Smoker Nonsmoker Fig. 7.6 Spermanalysisof smokersS;n=10and non-smokersNS;n=15 [430] .AIabstinenceintervalin days,p0.02;SVsemen volumeml;SZsemencells 10 7 ml;TSZtotalspermcount persample10 7 ml;p0.001; MSmotilesperm;TMS totalmotilesperm10 6 ml; p0.02.Thep-values indicatesigniicanceforthe comparisonSvs.NS notinluencedbydifferingserumlevelsofcalciumorphosphorusforreview,see [454] . Smokersandnon-smokersmaybehaveverydifferentlyintermsofcoffee,alcoholand vitaminDintakeandphysicalactivity [455] ,andreducedcalciumintakemayalsoleadto an increase in 1,25-OH 2 -D via a reduction in oestrogen levels [453, 456] . Oestrogen metabolism is increased by the induction of 2-hydroxylation of oestradiol in the liver increasedproductionof2-OH-oestrogens [457] ,andsmokinghasamorepronounced effectontheactivityoforallythanparenterallyadministeredoestrogens [458] .Oestrogens aremetabolisedmorerapidlyintheliverofsmokers,andthisinturnmayleadtoreduced PTHlevels.Similarly,theraisedcadmiumburdeninthekidneysmaycontributetothe reductionin1,25-OH 2 -D [459,460] .Owingtothisreductionin1,25-OH 2 -D,lesscal- ciumwouldbeabsorbed [461,462] andtakenupintobone.Reducedosteocalcinlevelsin smokersdiminishosteoblastactivity,ashasalsobeendemonstratedininvitroexperiments [463] .Calculatedintermsofdecades,bonedensitynaturallydeclinessigniicantly,even withoutsmoking,and25-OH-Dlevelscorrelatewithbonedensity [464,465] .Accordingto astudyfromDenmark,25-OH-Dand1,25-OH 2 -Dlevelsinsmokersarereducedby10 andPTHlevelsbyabout20 [453] .Thesereducedlevelsweredetectedin50ofsmokers [453] ,asalsoconirmedinanotherrecentlypublishedstudy [452] .Continuedsmoking doesnotalterbonealkalinephosphataseandurinaryhydroxyprolineexcretion [452] .7.7.2 Osteoporosis
Osteoporosisisassessedintermsofbonemineraldensity,andthecommonoccurrenceof femoralneckfracturesisimportantinthiscontext [466] .Theinluenceofsmokinghas beenatopicofcontroversialdiscussioninthepast [467] ,andresearchhasfocussedpar- ticularlyonpostmenopausalwomen.Anassociationbetweenbonemineraldensityand smokingwasalreadydemonstratedinthe1980s [467–470] .Insummary,amoderateeffect ofcigarettesmokingwasidentiiedonthereductioninbonemineraldensityofpre-and post-menopausalwomen.Thenumberofcigarettessmokeddailycorrelatedapproximately withbonemineraldensity [471] .Thiscorrelationwasindependentofbodyweight.Arela- tivelylargestudyin544menand822womendetecteddecreasesinhipbonemineral densityinsmokerscomparedwithnon-smokers [472] ,relectingthepositiveassociation betweensmokinganddecreasedbonemineraldensityinoldage. Theanti-osteoporoticeffectofhormonereplacementtherapyHRTwithoestrogens is attenuated by smoking whereas the anti-osteoporotic effect of raloxifene remains unchanged [473] .FemalesmokerswithalowBMIhaveanincreasedriskforboneloss, evenduringHRT [474] .Theageing-relatedriseinIL-6levelsisimportantforthepatho- genesis,andIL-6isfurtherincreasedbysmoking [475] . Menandwomenaged61–73years,bornandresidinginaruralareaofEnglandandat riskforcardiovasculardiseaseandosteoporosis,werecomparedwithacontrolgroupin termsofsmokinghabits [476] .Thedatarevealedreducedbonemineraldensityinmenand womenwhosmokedseeFig. 7.7 ,withgreaterdecreasesdetectedinthespinethaninthe femoralneck.Thesubjects’build,drinkinghabitsandphysicalactivitywerenotassoci- atedwiththereductioninbonemineraldensityFig. 7.8 [476] .Parts
» Tobacco Plants and Their Origin Use of Tobacco for Religious Purposes
» The Appropriation of Tobacco by Europeans
» Development of the Cigarette
» Objections to Smoking on Health Grounds
» Women Won Over by the Cigarette
» The Medical Use of Tobacco in the Nineteenth Century
» Tobacco Research in the Twentieth Century
» Tobacco Consumption in the Twentieth Century
» Cigarette Smoking in the USA Since 1965
» Cigarette-Related Mortality in Different Countries
» Smokers and Other Risk Factors
» Smoking Behaviour and Educational Level in the EU
» Non-Disclosure of Findings by the Tobacco Industry
» The Cigarette as a Vehicle for Nicotine Release
» Modifications of Nicotine Release
» Maintaining Nicotine Dependence Nicotine and Dependence
» Marketing of Cigarettes with a “Reduced” Health Risk
» Compensatory Behaviour by Smokers
» Optimising Nicotine Release Nicotine and Dependence
» Importance of Absorption Rate
» Ammonium and pH Manipulation
» Cigarettes with Reduced Tar Yield
» Agonists and Antagonists of the nAChR and its Subtypes
» Effects of Nicotine on Receptors in Different Organs
» Metabolic and Hormonal Effects of Nicotine
» Central Nervous System Effects of Nicotine
» Types of Dependence Nicotine Dependence
» Molecular Biological Aspects of Dependence
» Genetic Aspects Nicotine Dependence
» Withdrawal Symptoms Nicotine Dependence
» Immunological Reactions Caused by Cigarette Smoking
» Association Between Smoking and Lung Cancer
» Tobacco-Specific Carcinogens Genetic Factors That Increase the Risk for Bronchial Carcinoma
» The Cytochrome P450 and GST System and Carcinogenesis
» Peptide Receptors, Genetic Factors That Increase the Risk for Bronchial Carcinoma
» Exogenous Factors and Lung Cancer
» Pathophysiology of COPD Cigarette Smoking and COPD
» Genetic Factors Important Risk Factors for COPD
» Occupational and Environmental Factors
» Caveats Concerning the Informative Value of Studies
» Cigarette Smoking and Bronchial Asthma in Adults
» Bronchial Asthma in Children
» Other Lung Diseases Influenced by Cigarette Smoking
» Coronary Artery Disease and Myocardial Infarction
» Changes in Endothelial Function and Microcirculation
» Microcirculation and O Systemic Vascular Changes
» Arteriosclerotic and Inflammatory Vascular Reactions
» Genetic Factors Blood Coagulation and Fibrinolysis
» Nicotine and Ischaemic Heart Disease
» Cognitive Impairment Central Nervous System
» Influence on Cognitive Performance
» Intellectual Impairment in Childhood
» Smoker Personality Profiles and Genetic Inheritance of Smoking
» Peculiarities of the Smoker’s Personality
» Reasons for Increased Cigarette Consumption
» Comorbidity Between Depression and Smoking
» Extent of Cigarette Consumption
» Effects of Smoking in Forms of Dementia
» Smoking and Parkinson’s Disease
» Diabetic Retinopathy Ocular Diseases
» Graves’ Ophthalmopathy Ocular Diseases
» Macular Degeneration Ocular Diseases
» Ocular Tumours Ocular Diseases
» Retinal Detachment Ocular Diseases
» Lipid and Cholesterol Metabolism
» Insulin Resistance Diabetic Nephropathy
» Oesophageal Cancer Gastrointestinal Tract
» Gastrointestinal Ulcers Gastrointestinal Tract
» Cancers of the Gastrointestinal Tract
» Pancreatic Cancer Gastrointestinal Tract
» Toxic Substances and Inducers
» Kidney Cancer Urinary Tract Diseases
» Bladder Cancer Urinary Tract Diseases
» Prostatic Hyperplasia and Prostatic Cancer
» Fertility Disorders Urinary Tract Diseases
» Vitamin D and Oestrogen Metabolism
» Osteoporosis Disorders of Mineral Metabolism and Bone
» Hip Fractures Disorders of Mineral Metabolism and Bone
» Skin Changes Skin and Mucosa
» Skin Tumours Skin and Mucosa
» Breast Cancer Skin and Mucosa
» Effects of Smoking on the Placenta
» Malformations Possibly Caused by Smoking
» Smoking and Sudden Infant Death Syndrome SIDS
» Effects of Nicotine on the Foetus
» Medical Care Costs Attributable to Smoking During Pregnancy
» ETS in the Workplace and at Home
» Fibrinogen Cholesterol Endothelium and Platelets
» Markers of Inflammation Changes at the Molecular and Cellular Level
» Passive Smoking During and After Pregnancy
» Coronary Heart Disease Cardiovascular Disease
» Stroke and Subarachnoid Haemorrhage
» Respiratory Tract in Children and Teenagers
» Bronchial Carcinoma Respiratory Tract
» Indications and Diagnostic Considerations
» Self-Help Interventions by the Smoker
» Physician Advice for Smoking Cessation
» Group Behaviour Therapy Programmes
» Mass Media Communication Strategies
» E-Learning, Email and Internet for Smoking Cessation
» Evaluation of Nicotine Products
» Nicotine Chewing Gum Nicotine
» Nicotine Sublingual Tablet Nicotine Nasal Spray
» Treatment and Dosage Nicotine
» Nicotine Chewing Gum Adverse Events Associated with NRT
» Nicotine Patch Adverse Events Associated with NRT
» Nicotine Nasal Spray Adverse Events Associated with NRT
» Nicotine Inhaler Adverse Events Associated with NRT
» Nicotine Sublingual Tablet Adverse Events Associated with NRT
» Nicotine Lozenge Adverse Events Associated with NRT
» Drug Interactions During Smoking Cessation
» Contraindications for the Use of Nicotine Products
» Nicotine Formulations as OTC Products
» Contraindications and Drug Interactions
» Tranquillisers and Buspirone Other Pharmacotherapies
» Various Antidepressants Other Pharmacotherapies
» Opioid Antagonists Other Pharmacotherapies
» Silver Acetate Other Pharmacotherapies
» Therapeutic Monitoring in Smoking Cessation
» Ischaemic Heart Disease Special Therapeutic Situations
» Pregnancy Special Therapeutic Situations
» Weight Gain Special Therapeutic Situations
» Alcohol Consumption Special Therapeutic Situations
» Organic Depression Organic Depression and Schizophrenia
» Schizophrenic Patients Organic Depression and Schizophrenia
» Interactions Between Cigarette Smoking and Administration of Psychopharmaceuticals
» Pre-operative Smoking Cessation Special Therapeutic Situations
» Social Influence Inoculation Strategy
» Life Skills Strategy Prevention Programmes for Schools
» Class 2000 Health Promotion Programme
» Trier University Health Programme Long-Term Studies
» Role of Teachers in Primary Prevention
» Prevention by Restricting Sales of Tobacco Products to Minors
» Role of the Mass Media in Sales of Tobacco Products to Adolescents
» Role of Government and Community in Primary Prevention
» Effect of Tobacco Industry Advertising Messages
» Tobacco Advertising and Adolescent Smoking Initiation
» Advertising with “Light” Cigarettes
» Smoking Bans in Public Buildings and Public Spaces
» Tobacco Industry, Governmental and Non-governmental Organisations
» Politicians and Their Attitude to Smoking
» Scientists and the Tobacco Industry
» Governmental Control of Toxic Tobacco Constituents
» Bans on Advertising in Various Countries
» Tobacco Industry: Playing Down the Risks of Smoking and Passive Smoking
» Smoking and Non-smoking: Weighing the Benefits
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