Raise your hand, who knew that bone health is also part of the damage caused by smoking? There smoke-bone relationshipin fact, it has been known for some time, yet few are aware of it. An impact, that of cigarettes on the musculoskeletal system, which in too many still underestimate, or completely ignore. And precisely to raise awareness on the issue, the campaign of the Italian Society of Orthopedics and Traumatology (SIOT) Fighting smoking to the bone, started a few months ago with a national congress among the top experts on the subject.
Moreover, the Ixè-Siot survey submitted to the adherent orthopedists, had underlined that only 61% of adult citizens knew this negative effect.
But what are the consequences of cigarettes on bones?
There are many and, alas, rather alarming. To clarify, we asked the dr. Vittorio Di Giacomo, Head of Sports Traumatology Functional Unit – Humanitas San Pio X, to better explain what happens in the musculoskeletal system of smokers.
“While we all agree on the damage that smoking does to the lungs, it’s a matter of understanding what can hit the bone. First of all we must consider that bone is living matter and remodels itself every day thanks to of cells, the osteoblasti, which affix calcium through vitamin D building the bone matrix, which is the cement with which our bones are made. Like all cells in the body, these also need energy that reaches them through the blood vessels. Here, in fact, oxygen is transported, which is the gasoline to be able to function. Smoking can reduce microcirculation, which is the final part of the blood vessels where these exchanges take place. Also, by increasing the inhaled carbon monoxide, the percentage of oxygen is automatically reduced. Consequently the cells work less and add less calcium. In the healthy person this involves a increased risk of osteoporosis (the reduction of bone density) and therefore greater risk of fractures. And if the fracture has already occurred, smoking leads to a reduction in repair mechanisms, i.e. a lengthening of the healing time. Broadening the panorama, we have the same problem in the injury of the muscle, the ligament, the tendons: that is, in all those conditions in which repair mechanisms must be deployed, which need the vitality of our tissues “.
What problems are there with prosthetics and reconstruction procedures?
«In the field of interventions, as in the case of hip, shoulder and knee joint prostheses, the interface between the bone and the prosthesis is fundamental for healing. And the interface is given by the vitality of the bone that goes to take the prosthesis, binding itself. So, if there is damage to the microcirculation, the risk is that the prosthesis remains resting inside the bone and not in symbiosis with it. If this happens, eventually the prosthesis will move into the bone, and a new surgery will be necessary. As for the young patient who has to undergo the reconstruction of the cruciate, the biological time of about six months in which the bone takes the ligament and surrounds it, can lengthen to one year. Or not even happen. In these cases, there would be a new, reconstructed ligament, which, however, never attached itself to the bone. In short, a bad microcirculation lengthens the timing by about double. It can also be seen from the small scars. In the non-smoker the scar is closed in a week. In the smoker it takes two. It is clear that if the scar takes twice as much, everything else also takes twice as much ».
And at a young age?
«We often talk about the elderly, fractures and prostheses, but I see the biggest problems on the traumatology of sport. A boy who breaks a crusader and undergoes a double period of reparation means taking him out of business for a long time, after which he has to start over. In addition, a wound that does not heal well is subject to a higher risk of infection. I also consider it important to underline that a heavy smoker in adolescence reduces his reservoir of bone matrix because it knocks down the football apposition of his age. In practice, when we are young we fill our warehouse with bone matrix (for women until menarche, for men around 17-19), after which we gradually go to empty it. If we already consume it when we are young, it means that we will have very little of it when we are old. Therefore, smoking in adolescents also has this dramatic consequence ».
When a smoker is operated on, how does he behave?
«I ask as a condition of the intervention that smoking is stopped. Otherwise the recovery times are lengthened, in the case of the shoulder tendon, from three months to a year. Faced with that I usually get a good one feedback by the patient. Even if in 50% of cases the person resumes smoking after 3 months. But the good thing is that about 20% stop permanently ». And it’s not cheap.