Smoking shapes the relationship between metabolic biomarkers and femoral-neck bone mineral density: A stratified analysis by smoking status.

INTRODUCTION: Bone mineral density (BMD) is a crucial indicator of bone strength and osteoporosis risk. Smoking is known to negatively impact bone health and related bone metabolism biomarkers. However, if and how smoking status influences the relationship between bone metabolism biomarkers and BMD, particularly measured at the femoral neck, remains poorly understood. The objective of this study was to examine the relationship between bone metabolism biomarkers and BMD stratified by smoking status. METHODS: Data from 4464 healthy individuals were collected from the Qatar Biobank. The sample was divided into smokers, non-smokers, and ex-smokers, and logistic regression was used to examine relationships between biochemical markers and femoral-neck BMD in the different subgroups. RESULTS: Sex, age, and body mass index consistently influenced BMD across all smoking strata. Males and older individuals were at higher risk of low BMD, while higher BMI was protective. Creatinine levels were positively associated with BMD in all groups. Alkaline phosphate (ALP) was significantly associated with BMD in non-smokers and ex-smokers but not in smokers, while cholesterol levels were negatively associated with BMD in non-smokers and smokers but not in ex-smokers. CONCLUSIONS: Smoking status impacts the relationship between metabolism-related biomarkers and BMD, highlighting the need for smoking status-specific bone health guidelines. These findings emphasize the importance of including smoking history in clinical bone health assessments and suggest that personalized approaches may be necessary to mitigate the risk of bone deterioration.