Comparative Analysis of Bone Mineral Density in Smokers and Non-Smokers Through Dual-Energy X-ray Absorptiometry Scan at Hayatabad Medical Complex, Peshawar

Abstract

Background: Osteoporosis is an under-recognized health problem in men and is influenced by modifiable lifestyle factors, including cigarette smoking, which can disrupt bone remodeling and reduce bone mineral density, thereby increasing fracture risk. Objective: To compare BMD between smokers and non-smokers and evaluate exposure response relationships between smoking burden and low BMD among adult men undergoing DEXA scanning at Hayatabad Medical Complex, Peshawar. Methods: An analytical cross-sectional observational study was conducted among 312 adult male patients (156 smokers and 156 Non-smokers) who underwent lumbar spine DEXA between May and July 2025. BMD was categorized using WHO T-score criteria into normal, osteopenia, and osteoporosis. Smoking exposure was operationalized using cigarettes/day, duration of smoking, and pack-years. Group comparisons used chi-square tests and independent-samples tests as appropriate. Multivariable logistic regression estimated adjusted odds of low BMD (osteopenia/osteoporosis) controlling for age, BMI, physical activity, alcohol use, and diabetes. Results: Low BMD was more prevalent in smokers than non-smokers (67.9% vs 51.3%; p=0.004), and smokers had nearly twice the adjusted odds of low BMD (AOR=1.99; 95% CI: 1.28–3.09). Mean lumbar spine T-score was significantly lower in smokers (−1.78±1.02) than non-smokers (−1.34±0.96; mean difference −0.44; 95% CI: −0.69 to −0.19; p=0.001). A dose–response gradient was observed with higher cigarettes/day and longer smoking duration. Conclusion: Cigarette smoking is independently associated with lower lumbar spine BMD in Pakistani men, with evidence of an exposure response relationship, supporting targeted DEXA screening and smoking cessation to reduce osteoporosis risk