exposure may occur in young adults.

smokers, smokeless tobacco users, and individuals without tobacco habits.

categorized into three equal groups: smokers, smokeless tobacco users, and non-users. Bone mineral density was

evaluated at the calcaneum using a portable SONOST 2000 peripheral DEXA system. Based on T-score values,

participants were classified as normal, osteopenic, or osteoporotic.

Statistical analysis was carried out using SPSS version 21.0. Differences in mean T-scores were analyzed using

one-way ANOVA, while associations between tobacco exposure and BMD status were examined using the Chi-

square test. Correlation analysis was performed to determine the relationship between smoking intensity,

Preventive measures, including early screening and tobacco cessation counseling, are essential to minimize long-

term skeletal complications.

Tobacco Exposure; Osteopenia; Risk Factors

Osteoporosis is a systemic skeletal disorder characterized by decreased bone mass and microarchitectural

deterioration of bone tissue, leading to increased bone fragility and susceptibility to fractures.[1] Although

osteoporosis is commonly regarded as a disease predominantly affecting women, a substantial proportion of

osteoporotic fractures also occur in men.[2] The World Health Organization (WHO) defines osteoporosis based

on Bone Mineral Density (BMD) measurement using Dual Energy X-ray Absorptiometry (DEXA), where a T-

The adverse skeletal effects of smoking are mediated through multiple mechanisms, including direct toxicity of

nicotine on osteoblasts, inhibition of collagen synthesis, increased bone resorption, and premature osteoblast

apoptosis.[9,10] Additionally, smoking indirectly impairs bone health by reducing intestinal calcium absorption,

altering steroid hormone levels, and affecting estrogen metabolism.[11–14]

Epidemiological studies have demonstrated that smokers exhibit significantly lower BMD compared to non-

smokers, with the risk increasing proportionally to duration and intensity of smoking.[6,15,16] Furthermore,

combined tobacco exposure, including smokeless tobacco use, has also been associated with compromised bone

health.[16] Given the rising prevalence of tobacco use among young and middle-aged adults, early identification

of tobacco-related bone loss is crucial to prevent long-term skeletal complications.

Therefore, the present study was undertaken to determine the incidence of osteoporosis among adult smokers

To measure bone mineral density (BMD) in smokers, smokeless tobacco users, and non-smokers using

peripheral DEXA.To compare mean T-scores among the three groups.To determine the prevalence of osteopenia

and osteoporosis based on WHO diagnostic criteria.To assess the association between tobacco use and bone

mineral density.

This observational cross-sectional study was conducted in the Department of Oral Medicine and Radiology.

A total of 90 participants aged 20–45 years were included and divided equally into three groups: Group I –

Pregnant or lactating women, patients with systemic diseases affecting bone metabolism, individuals on calcium,

bisphosphonate, or steroid therapy, patients previously diagnosed with osteoporosis, history of heel trauma or

pathology.

Bone Mineral Density was assessed using a portable SONOST 2000 peripheral Dual Energy X-ray

Absorptiometry (DEXA) device. Measurements were taken at the calcaneum.

2.5.

0.05 was considered statistically significant with 95% confidence interval and 80% study power.

4 (13.3%)

8 (26.7%)

15 (50.0%)

16 (53.3%)

11 (36.7%)

6 (20.0%)

30 (100%)

30 (100%)

moderate prevalence (20%). Non-smokers predominantly had normal BMD (70%). The association between

tobacco habit and BMD category was statistically significant (p = 0.001). Table presents the distribution of Bone

Mineral Density (BMD) categories among smokers, smokeless tobacco users, and non-smokers. The findings

show that smokers had the highest prevalence of osteoporosis (36.7%), followed by smokeless tobacco users

(20.0%), while only 3.3% of non-smokers were osteoporotic. A majority of non-smokers (70.0%) had normal

BMD compared to only 13.3% of smokers. Osteopenia was most commonly observed among smokeless tobacco

users (53.3%) and smokers (50.0%). Overall, the results demonstrate a clear trend of reduced bone mineral

density among tobacco users, particularly smokers. The association between tobacco habit and BMD category

was found to be statistically significant (Chi-square test, p = 0.001), indicating that tobacco use is significantly

related to increased risk of osteopenia and osteoporosis. These findings support the rejection of the null

These findings are consistent with the meta-analysis by Ward and Klesges,[6] which reported a significant

negative association between cigarette smoking and bone mineral density. Similarly, Höidrup et al.[7] observed

increased hip fracture risk among smokers across different age groups.

The direct toxic effect of nicotine on osteoblast function, including inhibition of collagen synthesis and increased

bone resorption, has been documented in experimental studies.[9,10] Additionally, smoking interferes with

calcium absorption and estrogen metabolism, further contributing to reduced bone mass.[11–14]

Krall and Dawson-Hughes[11] reported accelerated bone loss among smokers compared to non-smokers. Kim

et al.[15] also demonstrated an association between secondhand smoke exposure and osteoporosis in

postmenopausal women. Furthermore, Ayo-Yousaf[16] observed that combined tobacco exposure significantly

increases osteoporosis risk.

Smoking is significantly associated with decreased bone mineral density and increased prevalence of

osteoporosis. The severity of bone loss correlates with duration and frequency of smoking. Preventive strategies,

including tobacco cessation programs and early BMD screening, are recommended to reduce long-term skeletal