Overturning conventional wisdom, a large study of middle-aged to elderly smokers has found that men are more likely than women to have the progressive bone disease osteoporosis and fractures of their vertebrae.
Although current guidelines in the US do not recommend osteoporosis screening for men, the new findings suggest that smokers of both genders should be screened for low bone density.
The researchers found that smoking history and chronic obstructive pulmonary disease (COPD) were independent risk factors for low bone density among both men and women.
While current smoking is a recognised risk factor for osteoporosis, neither smoking history nor COPD are among criteria for bone-density screening.
"Our findings suggest that current and past smokers of both genders should be screened for osteoporosis," said Elizabeth Regan, assistant professor of medicine at the National Jewish Health in the US.
"Expanding screening to include men with a smoking history and starting treatment in those with bone disease may prevent fractures, improve quality of life and reduce health care costs," Regan added.
The researchers evaluated 3,321 current and former smokers aged 45 to 80.
Men accounted for 55% of the smokers with low bone density and 60% of those with vertebral fractures.
Low-bone density increased in prevalence with worsening COPD, rising to 84% among severe COPD patients of both genders, the findings showed.
"The growing use of CT scans to screen heavy smokers for lung cancer may provide an opportunity to use the same scans for bone density screening in this high-risk population," Regan pointed out.
The study was published online in the journal Annals of the American Thoracic Society.