Review Article

The Effect of Tobacco Smoking on Musculoskeletal Health: A Systematic Review

Table 2

Summary for the effect of smoking on major outcomes of musculoskeletal health.

OutcomesContext of the body of evidenceSize of the body of evidence (number)Quality of the body of evidenceConsistency of the body of evidenceStrength of a body of evidence

Effect of smoking on bones

Decreased BMDRelevant and globalLarge (24)HighHighly consistentVery strong

Decreased BMCRelevant but specificSmall (3)HighLow level of consistencyLimited

Increased risk for fractureRelevant and globalLarge (6)HighHighly consistentVery strong

Delayed fracture healingRelevant and globalLarge (5)HighHighly consistentVery strong

Increased alveolar bone lossRelevant and globalMedium (9)HighModerately consistentStrong

Poor periodontal parametersRelevant and globalLarge (17)HighHighly consistentVery strong

Increased bone implant failureRelevant and globalLarge (13)HighHighly consistentVery strong

Poor histometric parameters for tissues surround implantsRelevant but specificSmall (4)HighHighly consistentStrong

Effect of smoking on joints

Increased RA disease activityRelevant and globalMedium (5)HighModerately consistentMedium

Increased remission of RARelevant but specificSmall (2)HighInconsistentLimited

Increased RA progressionRelevant but specificSmall (2)HighInconsistentLimited

Poor response to RA therapiesRelevant and globalLarge (10)HighHighly consistentVery strong

Decreased incidence/prevalence of OARelevant but specificSmall (4)HighLow level of consistencyLimited

Increased pain score associated with OARelevant but specificSmall (2)HighConsistentMedium

Increased risk for total joint replacement in OA patientsRelevant but specificSmall (2)HighInconsistentLimited

Increased risk for complications after joint replacement in OARelevant and globalSmall (4)HighHighly consistentStrong

Increased SA diseased activityRelevant and globalSmall (3)ModerateHighly consistentMedium

Increased pain intensity in patients with TMDRelevant and globalSmall (4)HighModerately consistentStrong

Effect of smoking on muscle

Decreased muscle strengthRelevant and globalMedium (6)HighHighly consistentVery strong

Decreased maximal muscle voluntary contractionRelevant but specificSmall (3)HighLow level of consistencyLimited

Effect of smoking on cartilage

Increased volume of knee joint cartilageRelevant but specificSmall (2)HighConsistentMedium

Increased defect of knee joint cartilageRelevant but specificSmall (2)HighMixedLimited

Poor postoperative outcomes after knee joint surgeryRelevant but specificSmall (3)HighHighly consistentStrong

Increased risk for spinal reoperationRelevant but specificSmall (3)HighHighly consistentStrong

Decreased spinal fusion rateRelevant and globalSmall (4)ModerateModerately consistentMedium

Effect of smoking on tendons

Increased severity of rotator cuff tearsRelevant but specificSmall (2)HighConsistentMedium

Poor outcomes after rotator cuff reconstructionRelevant but specificSmall (2)HighConsistentMedium

Effect of smoking on ligaments

Poor functional and stability scores after ACL reconstructionRelevant and globalSmall (4)HighModerately consistentMedium