폐경 후 여성에서 흡연이 골다공증성 척추 골절에 미치는 영향 = Effect of Smoking on Osteoporotic Vertebral Fracture in Postmenopausal Women

다국어 초록 (Multilingual Abstract)

Study Design: A retrospective study.
Objectives: To evaluate the association between smoking and osteoporotic vertebral fractures (OVFs) in postmenopausal women.
Summary of Literature Review: Several studies have examined the relationship of smoking with hip fractures, but few studies have analyzed the relationship of smoking with spine fractures in women thus far.
Materials and Methods: This study considered 1255 postmenopausal women aged 50 years and older (enrollment from April 2008 to January 2009) from 62 study sites in a nationwide hospital. The amount of smoking was calculated in pack-years. Further, OVFs were diagnosed using a semi-quantitative method. To analyze the relationship between smoking and OVFs, we used a paired t-test, a χ2-test, and a binary logistic regression analysis.
Results: The past history of smoking was 7.2% in the patient group and 4.3% in the control group (p=0.025). The mean pack-years of smoking was 0.34 in the control group and 0.62 in the patient group (p=130). The mean T-score in the lumbar bone mass density (BMD) was –1.64 in the control group and –2.19 in the patient group (p=0.409). Smoking was a risk factor of vertebral fractures in postmenopausal women (odd’s ratio=1.68, 95% confidence interval=1.020–2.759, p=0.042) irrespective of the lumbar BMD and the medical treatment for osteoporosis and obesity.
Conclusions: Smoking is a risk factor for osteoporotic vertebral fractures in postmenopausal women independently without regard to lumbar BMD. Therefore, cessation of smoking is important for the prevention of OVFs in postmenopausal women.

국문 초록 (Abstract)

연구 계획: 후향적 연구.
목적: 폐경 후 여성에서 흡연이 골다공증성 척추 골절과 골밀도에 미치는 영향을 분석하고자 하였다.
선행문헌의 요약: 흡연이 골밀도를 낮추고 골대사에 해로운 작용을 하며 특히 고관절부의 골다공증성 골절의 발생률을 증가시키는 것은 기존의 여러 논문을통하여 알려진 바 있다. 그러나 여성 환자에서 척추 골절의 발생에 대한 흡연의 영향에 대해서는 연구된 바가 거의 없었다.
대상 및 방법: 1255명의 50세 이상 폐경 후 여성을 대상으로 흡연력을 갑년 단위로 조사하였다. 척추 골절의 진단은 흉요추부 측면 방사선 사진에서 반정량적 방법을 이용하여 진단하였다. 대상군을 척추 골절이 한 개 이상 있는 골절군과 척추 골절이 없는 대조군으로 나누어 두 군간의 차이를 통계학적으로 분석하였다.
결과: 흡연력의 경우 골절군에서 7.2%였으며, 대조군에서 4.3%로 골절군에서 유의하게 높은 것으로 나타났다(p=0.025). 평균 흡연 갑년수는 골절군에서는0.63갑년, 대조군에서는 0.34갑년이었으며, 통계학적으로 유의한 차이는 없었다(p=0.130). 흡연력은 골다공증성 척추 골절의 주요한 위험인자로 나타났으며 골다공증 여부, 골다공증 치료 기왕력, 비만의 여부 등을 통제하였을 때, 비흡연자에 비해 척추 골절의 발생을 1.68배 높이는 것으로 나타났다(OR 1.68, 95%CI 1.020-2.759, p=0.042).
결론: 흡연력은 폐경 후 여성에서 골밀도와 상관 없이 척추 골절의 유의한 위험 인자로 나타났다. 여성에서 금연이 척추 골절의 예방을 위해 필요할 것으로 생각된다.

참고문헌 (Reference)

1 Ensrud KE, "Weight change and fractures in older women. Study of Osteoporotic Fractures Research Group" 157 : 857-863, 1997

2 Genant HK, "Vertebral fracture assessment using a semiquantitative technique" 8 : 1137-1148, 1993

3 Hoidrup S, "Tobacco smoking and risk of hip fracture in men and women" 29 : 253-259, 2000

4 Brot C, "The influence of smoking on vitamin D status and calcium metabolism" 53 : 920-926, 1999

5 Riebel GD, "The effect of nicotine on incorporation of cancellous bone graft in an animal model" 20 : 2198-2202, 1995

6 Baron JA, "The effect of cigarette smoking on adrenal cortical hormones" 272 : 151-155, 1995

7 Broulik PD, "The effect of chronic nicotine administration on bone mineral content and bone strength in normal and castrated male rats" 39 : 20-24, 2007

8 Cornuz J, "Smoking, smoking cessation, and risk of hip fracture in women" 106 : 311-314, 1999

9 Kanis JA, "Smoking and fracture risk: a meta-analysis" 16 : 155-162, 2005

10 Kim KH, "Secondhand smoke exposure and osteoporosis in never-smoking postmenopausal women: the Fourth Korea National Health and Nutrition Examination Survey" 24 : 523-532, 2013

11 Hemenway D, "Risk factors for wrist fracture: effect of age, cigarettes, alcohol, body height, relative weight, and handedness on the risk for distal forearm fractures in men" 140 : 361-367, 1994

12 Kim KH, "Prevalence, awareness, and treatment of osteoporosis among Korean women: The Fourth Korea National Health and Nutrition Examination Survey" 50 : 1039-1047, 2012

13 "Osteoporosis: review of the evidence for prevention, diagnosis and treatment and cost-effectiveness analysis. Introduction" 8 (8): S7-S80, 1998

14 Rothem DE, "Nicotine modulates bone metabolism-associated gene expression in osteoblast cells" 27 : 555-561, 2009

15 Svendsen OL, "Impact of soft tissue on in vivo accuracy of bone mineral measurements in the spine, hip, and forearm: a human cadaver study" 10 : 868-873, 1995

16 Vestergaard P, "Fracture risk associated with smoking: a meta-analysis" 254 : 572-583, 2003

17 Felson DT, "Effects of weight and body mass index on bone mineral density in men and women: the Framingham study" 8 : 567-573, 1993

18 Williams AR, "Effect of weight, smoking, and estrogen use on the risk of hip and forearm fractures in postmenopausal women" 60 : 695-699, 1982

19 Jensen J, "Cigarette smoking, serum estrogens, and bone loss during hormonereplacement therapy early after menopause" 313 : 973-975, 1985

20 Kaufman DW, "Cigarette smoking and age at natural menopause" 70 : 420-422, 1980

21 Tanko LB, "An update on the antiestrogenic effect of smoking: a literature review with implications for researchers and practitioners" 11 : 104-109, 2004

22 Johnell O, "An estimate of the worldwide prevalence and disability associated with osteoporotic fractures" 17 : 1726-1733, 2006

23 Law MR, "A meta-analysis of cigarette smoking, bone mineral density and risk of hip fracture: recognition of a major effect" 315 : 841-846, 1997