The Anti-Smokers Lied About Osteoporosis And About Estrogen

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Antismokers grasping at straws:
Lying at any cost, even when all the evidence is against them

The media flooded the country with the anti-smoker claim that smoking increases osteoporosis (Danielle HW. Osteoporosis of the slender smoker. Arch Intern Med 1976;136:298-304). 

There was no publicity when the claim was later refuted (Jensen GF. Osteoporosis of the slender smoker revisited by epidemiologic approach. Eur J Clin Investig 1986;16:239-242).

The Danielle study used two "ill-defined" patient populations; the second included all 70 year-old women in nine suburbs of Copenhagen, and had more cases, 180 versus 72. The first asserted that there was no relation between weight and bone mass in non-smokers, while the second, and most other studies, have found correlation in both.

Most importantly, there was no difference between smokers and non-smokers in the frequency of definite osteoporotic or other fractures. The smokers actually had fewer. Since all the cases were the same age, there is no way to use age adjustment to manipulate the data. Referring to smoking, another researcher has admitted, "this factor is a more manipulable one than some of the other factors which have been shown to be important in the etiology of fracture."

A number of studies have found that smokers have slightly higher bone mass and density than non-smokers, both pre- or post-menopausal. "No association between bone mass and smoking was observed. A subgroup with patterns of substantial combined tobacco and alcohol use having a lower mean bone mass could not be identified"(MF Sowers et al. Prev Med 1985;14:585-596). "Smoking history in pack years did not correlate with bone density at either skeletal site," spine or forearm (MM Luckey et al. J Clin Endocrinol Metab 1989;69:762-770).

In the Framingham Study, Felson et al found that "Cigarette smoking was not associated with risk of fracture in any analyses including models without alcohol." This was in 217 cases, 174 of them female, in an ongoing prospective of over 40 years' duration (Felson DT et al. Am J Epidemiol 1988;128(5):1102-1110).

And in a study the next year which separately analyzed radiographs of the white, middle class Framingham subjects, and poorer, more nonwhite HANES I subjects, Felson also found a borderline statistically significant protective association between smoking and osteoarthritis, which was strongest in the heaviest smokers (Arthr Rheum 1989;32:166-172).

However, true to their anti-smoker psychosis, they had to find something bad to say about smoking. Although they admitted that very few of their subjects ever used estrogen, they claimed that smokers did not benefit from estrogen therapy on the basis of a mere 29 ever-users, 8 of them smokers.

Never mind that this claim was opposite to that of a large 1982 study which claimed both big risks of fractures, and big benefits from estrogen for smokers. With this study, the anti-smokers could simultaneously fear-monger against smoking and promote pharmacological intervention.

But in the "Nurses Study,"(D Hemenway, AJPH Dec 1988;78(12):1554-1558), which is possibly the largest to date with 925 cases, the researchers said, "We observed no relation between smoking categories and likelihood of fracture either overall or within any five-year age category....Most similar-aged women in the study -- whether thin or fat, smoking or non-smoking, teetotalers or drinkers -- generally had an equivalent chance of sustaining a hip or forearm fracture."

Meanwhile, the anti-smokers embellished their mythical smokers' osteoporosis with speculation that this was the result of smoking-induced low estrogen levels. The wished-for evidence was produced by studies which measured urinary estrogen, which is known to fluctuate with temperature and even mild exercise (MacMahon NEJM 1982;307:1062-1065 and Michnovitz NEJM 1986;315(21):1305-1309). Yet many anti-smokers cite these studies as if they are definitive proof.

Later studies which measured serum levels showed the low estrogen claim was false. "These results indicate that smoking does not alter the production and metabolism of androgens and estrogens in pre and postmenopausal women."(Longcope, J Clin Endocrinol Metab 1988;67(2):379-383).

"Mean estrogen levels were higher (though not significantly), rather than lower, in the smokers than in the nonsmokers"(K-T Khaw NEJM 1988; 318(26):1705-1709). 

They rationalized that maybe their assay wasn't sensitive enough. Also Friedman et al. (Fertil Steril 1987;47:398-401), found no difference, but showed their anti-smoker need to believe the lies by speculating that "hypercortisolism associated with smoking may increase the risk of osteoporosis," despite finding higher bone mineral density in smokers.

Undaunted, the anti-smokers downplayed these adverse findings. Although they found that "smoking does not lead to reduced serum concentrations of oestrogen in postmenopausal women," and that "smoking does not interfere with the conversion processes" of hormones, this was not what we were told.

Instead, they twisted their finding of a minor elevation of a hormone precursor into the bizarre conclusion -- unwarranted and unsubstantiated in their own study or any other -- that female smokers are masculinized.  Anti-smokers and others who have been worn down by the repeated mis-interpretations and selective quotes in otherwise sound studies picked up on this and the discredited earlier claims of reduced estrogen to create a grotesque, chimerical caricature to degrade women smokers. This isn't science.  It does not even qualify as adequate reading comprehension.

Finally, according to investigators who made daily measurements: "There is now substantial evidence that smoking does not decrease endogenous serum E2 in either premenopausal or postmenopausal women...We found no difference in endogneous serum E2 between premenopausal or postmenopausal smokers and non-smokers matched for BMI, in agreement with previous investigations" [10,13-16].

"The consistency of these results makes it now very unlikely that endogenous E2 differs between smokers and nonsmokers. Our results also suggest that cigarette smoking has no effect on serum Pg in premenopausal women." (Key TJA et al. Cigarette smoking and steroid hormones in women. J Steroid Molec Biol 1991;39 (4A):529-534).

Courtesy of Carol Thompson 08/23/93
Smokers' Rights Action Group Smokers' Rights Action Group P.O. Box 259575 Madison, WI 53725-9575 Phone: 608-249-4568

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