U Penn Researchers Say Smoking Can Slow Bone Healing

According to University of Pennsylvania researchers, smokers may have one more reason to be concerned about their health. A new study from the University’s Perelman School of Medicine, Department of Orthopedic Surgery, corroborates early evidence that cigarette smoking leads to longer healing times and an increased rate of post-operative complication and infection for patients that fracture or sustain traumatic injuries to their bones.

“Cigarette smoking is widely recognized as one of the major causes of preventable disease in the United States, but there has been a lack of evidence showing other side effects of smoking, such as how it changes the way our bones heal,” said Samir Mehta, M.D., chief of the orthopedic trauma and fracture service at Penn Medicine. “Our study adds substantial support to a growing body of evidence showing that smoking presents a significant risk to fracture patients. These risks need to be addressed with the patient both at the time of injury and when considering surgical treatment.”

Results of the study show that for all injury types, fractured bones in patients who smoke take roughly six weeks longer to heal than those in a non-smoker (30.2 weeks compared to 24.1 weeks). Additional results show that fractured bones in patients who smoke are 2.3 times more likely to result in non-unions (non-healed fractures) than in non-smokers.

Using Medline, EMBASE and Cochrane computerized literature databases, the researchers collated previous studies that have examined the effects of smoking on bone and soft tissue healing. By analyzing these studies, the team sought to find an association between smoking and healing time, and various complications such as post-surgical infection. Studies included in the analysis focused on fractures of the tibia, femur or hip, ankle, humerus, and multiple long bones. In total, 6,480 patient cases (treated both surgically and non-surgically) were evaluated in the studies.

With approximately 6.8 million fractures requiring medical treatment in the United States annually, the overall burden of musculoskeletal disease is substantial. Though recent efforts have been made to promote bone health through vitamin and mineral supplements and nutritional support, the research team contended that altering social factors such as encouraging smoking cessation have been under-addressed. This void is causing both a disconnect in the short-term treatment for patients and a missed opportunity to improve long-term health.

“The effects of smoking intervention programs need to be discussed and instituted to promote better outcomes for post-fracture patients,” said Mehta. “We have an opportunity to help patients understand that it’s about more than just heart health, and that smoking puts you at a higher risk of complications and leads to longer healing times.”

According to the research team, future studies are needed to evaluate the dose-dependent effects of smoking on fracture healing. In addition, the increasing use and production of smokeless tobacco presents new questions about the effects of nicotine and other tobacco products through non-combustible forms. Finally, studies that better delineate the impact of directed education and the effects of the timing of smoking cessation (both before and after surgery) on the post-operative complication rate also are needed to provide the best care for fracture patients.

Lead author on the study is Jaimo Ahn, M.D., assistant professor of orthopedic surgery at Penn Medicine. Other Penn authors include Mara L. Schenker, M.D., John A. Scolaro, M.D., Sarah M. Yannascoli, M.D., and Keith D. Baldwin, M.D. Schenker presented the results of the study at the annual meeting of the American Association of Orthopedic Surgeons (AAOS) in Chicago, Ill., last week.