Association between secondhand smoke exposure and osteoporosis risk in postmenopausal women: a cross-sectional analysis of NHANES data

This study aimed to investigate the association between smoke exposure and the risk of osteoporosis in postmenopausal women in the United States, using data from the National Health and Nutrition Examination Survey (NHANES). A cross-sectional analysis was conducted using NHANES data from 2005 to 2010, 2013 to 2014, and 2017 to 2018. The study population consisted of postmenopausal women aged 18 years and older. Their bone health status was assessed using self-reported osteoporosis and dual-energy X-ray absorptiometry (DXA) measurements, smoke exposure was evaluated through serum cotinine levels, and multivariate logistic regression models were used to examine the association between smoke exposure and osteoporosis risk, adjusting for sociodemographic factors, health behaviours, and comorbidities. The analysis comprised 4,140 postmenopausal women, and data analysis showed that active smoking was significantly associated with an increased risk of osteoporosis, with an adjusted odds ratio (OR) of 2.020 (95% confidence interval [CI]: 1.35–3.03), after adjusting for potential confounders. Additionally, age, race/ethnicity, socioeconomic status, marital status, and body mass index were identified as significant predictors of osteoporosis risk. Smoke exposure, particularly active smoking, was associated with an elevated risk of osteoporosis among postmenopausal women in the United States. The findings underscore the need to address modifiable risk factors, such as smoking cessation, and implement targeted interventions to mitigate disparities in bone health. This study examined the relationship between smoke exposure and osteoporosis risk among postmenopausal women using data from NHANES. The findings show that active smoking significantly increased the likelihood of osteoporosis, even after adjusting for sociodemographic and health-related factors. In contrast, passive smoking had a weaker association with osteoporosis, and the analysis also identified additional predictors of osteoporosis risk, including age, race, socioeconomic status, and body mass index. Thus, interventions targeting modifiable risk factors, such as smoking cessation and addressing socioeconomic disparities, could help reduce osteoporosis risk in this vulnerable population, emphasising the need of raising awareness about bone health among postmenopausal women.