Smoking has a significant negative impact on mortality after fractures, primarily because it impairs the body’s ability to heal bones and recover from injury. People who smoke experience slower and less effective bone healing, which increases the risk of complications such as nonunion (where the bone fails to heal properly) and infections at the fracture site. These complications can prolong recovery time, increase the likelihood of additional surgeries, and ultimately raise the risk of death following a fracture.
Nicotine, a key component of cigarette smoke, causes persistent narrowing of blood vessels (vasoconstriction), which reduces blood flow and oxygen delivery to tissues, including bones. This diminished blood supply slows down the healing process and weakens bone structure by increasing porosity and reducing bone density. Smoking also disrupts the balance of hormones and chemicals important for bone metabolism, such as cortisol and calcitonin, further impairing bone repair and increasing fracture risk.
Beyond the local effects on bone healing, smoking compromises overall health in ways that can worsen outcomes after fractures. It impairs lung function and weakens the immune system, making smokers more vulnerable to respiratory infections and sepsis during recovery. The increased demand on the heart and reduced oxygen availability also raise the risk of cardiovascular events like heart attacks during the healing period. These systemic effects contribute to higher rates of surgical complications, longer hospital stays, and increased mortality after fractures.
In addition to these physiological effects, smokers tend to report worse pain relief and functional recovery after surgeries related to fractures, such as spinal fusions. They are also more likely to require revision surgeries due to complications or recurrent problems. This combination of impaired healing, increased complications, and poorer overall health creates a scenario where smoking significantly elevates the risk of death following fractures.
Older adults, who are already at higher risk for fractures and mortality due to factors like sarcopenia (loss of muscle mass and strength), face even greater challenges if they smoke. Muscle weakness and poor physical function increase the risk of falls and fractures, and when combined with smoking-related healing impairments, the chances of adverse outcomes rise further.
In summary, smoking increases mortality after fractures by slowing bone healing, increasing the risk of infections and surgical complications, impairing immune and lung function, and contributing to cardiovascular stress. These effects lead to prolonged recovery, higher rates of additional surgeries, and greater vulnerability to life-threatening complications during the healing process.
