There appears to be no end to the harmful effects of smoking, with damage to muscles, bones and joints joining the list.

Dr Scott Porter, author of a new study in the Journal of the American Academy of Orthopaedic Surgeons, says, "The effects of smoking on a person’s cardiovascular health are well documented. What many smokers may not realise is that smoking also has a negative impact on muscoskeletal health." "Studies have shown that nicotine lessens the benefits of oestrogen, decreasing a smoker’s ability to form bone and putting them at risk of osteoporosis", say researchers. In the case of osteoporotic post-menopausal women, it has also been found to accelerate the bone loss. Co-author Dr Edward Hanley, of Carolinas Medical Center in the US, says, "Women who smoke have significantly less bone mass, which may be due in part to nicotine’s inhibition of oestrogen." Male smokers also are at increased risk of developing osteoporosis because smoking affects the production of bone cells. The study, based on a literature review of scientific data on the relationship between smoking and muscoskeletal disease, adds that smokers who have wounds or surgical incision often take longer to heal than non-smokers. Dr Hanley explains that this is because smokers’ tissues do not get the necessary amount of oxygen for repairs. He said, "As a result, it is more difficult for smokers to recover from breaking a bone. Cigarette smoking also slows the healing after orthopaedic surgical procedures. For example, it specifically decreases the rate of both healing and success after spinal fusion." The researchers found that many of those experiencing low back pain were smokers. They add that it may be possible that heart disease, which can be caused by smoking, can initiate low back pain symptoms because the lumbar discs may be malnourished from the lack of adequate blood supply. Smoking may also be an indicator of poor health and lifestyle, which contribute to the development of low back pain.

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