Damaged bones surrounded by cigarette smoke, protected by antioxidants.

Clearing the Air: How Nicotine and Smoking Impact Your Bone Health

Kai Mendoza in Health & Wellness November 2025 • 4 min read.

"Uncover the surprising effects of nicotine and smoking on bone health, and what you can do to protect yourself."

For decades, cigarette smoking has been linked to osteoporosis. Research consistently shows a direct correlation between smoking, decreased bone mineral density, and impaired fracture healing. The exact mechanisms behind this remain unclear, although the migration and osteogenesis (bone formation) of mesenchymal stem/stromal cells (MSCs) into fracture sites play a vital role.

Nicotine, the addictive substance in tobacco, quickly turns into cotinine in the body. The study sheds light on how these chemicals affect bone regeneration at a cellular level, providing insights that could lead to better treatments for smokers with fractures.

This article will explore the impacts of nicotine and cotinine on bone cells, reveal how cigarette smoke induces oxidative stress, and offer potential therapeutic strategies to support bone health in smokers.

Nicotine and Cotinine: What's the Real Impact on Bone Cells?

Damaged bones surrounded by cigarette smoke, protected by antioxidants.

Scientists tested nicotine and cotinine on human mesenchymal stem cells (SCP-1), which are important for bone repair. Concentrations of nicotine ranged from 50 ng/ml to 320 ng/ml, and cotinine from 100 ng/ml to 300 ng/ml—levels mirroring what’s found in smokers' blood. Surprisingly, these amounts of nicotine and cotinine didn't directly stop the stem cells from turning into bone cells.

The cells' mitochondrial activity (a sign of health) and ability to create bone matrix were unaffected. Even the structure of primary cilia, tiny cell parts important for bone formation, remained normal. These findings suggest nicotine and cotinine alone may not be the main culprits in smoking-related bone damage.

Mitochondrial Activity: Cell health and energy production remained stable.
Bone Matrix Production: The cells continued to build the structural components of bone.
Primary Cilia Structure: These critical cellular antennas were unperturbed.

While nicotine and cotinine themselves might not directly harm bone cells, the experiment revealed they don't protect against other harmful effects of cigarette smoke. This suggests the real danger lies in the combined effects of numerous chemicals found in smoke.

The Big Picture: Protecting Your Bones from Smoke's Harmful Effects

This research underscores the importance of protecting bone health, especially for smokers. While nicotine replacement might seem like a safer alternative, this study highlights that the broader impact of cigarette smoke—particularly oxidative stress—is a significant concern. Further research into antioxidants and Nrf2 activation could pave the way for new treatments to help smokers maintain stronger bones and recover from fractures more effectively.

About this Article -

This article was crafted using a human-AI hybrid and collaborative approach. AI assisted our team with initial drafting, research insights, identifying key questions, and image generation. Our human editors guided topic selection, defined the angle, structured the content, ensured factual accuracy and relevance, refined the tone, and conducted thorough editing to deliver helpful, high-quality information.See our About page for more information.

This article is based on research published under:

DOI-LINK: 10.1155/2018/3172480, Alternate LINK

Title: Nicotine And Cotinine Inhibit Catalase And Glutathione Reductase Activity Contributing To The Impaired Osteogenesis Of Scp-1 Cells Exposed To Cigarette Smoke

Subject: Cell Biology

Journal: Oxidative Medicine and Cellular Longevity

Publisher: Hindawi Limited

Authors: Romina H. Aspera-Werz, Sabrina Ehnert, Daniel Heid, Sheng Zhu, Tao Chen, Bianca Braun, Vrinda Sreekumar, Christian Arnscheidt, Andreas K. Nussler

Published: 2018-11-06

Everything You Need To Know

How does smoking impact bone health, and what specific effects have been observed?

Research indicates a correlation between cigarette smoking and decreased bone mineral density, as well as impaired fracture healing. The underlying mechanisms are still being investigated, but it's believed that the migration and osteogenesis, or bone formation, of mesenchymal stem/stromal cells (MSCs) into fracture sites plays a significant role. Further studies are needed to fully understand this complex relationship.

In the study, how were nicotine and cotinine tested on bone cells, and what were the surprising initial results?

Scientists tested nicotine and cotinine on human mesenchymal stem cells (SCP-1) at concentrations mirroring levels found in smokers' blood. The findings revealed that these amounts of nicotine and cotinine didn't directly halt the stem cells from transforming into bone cells, suggesting that the broader impact of cigarette smoke, especially oxidative stress, could be a more significant concern.

What specific cellular functions were assessed in the mesenchymal stem cell (SCP-1) experiment, and why are these functions important for bone health?

The study on human mesenchymal stem cells (SCP-1) evaluated mitochondrial activity, bone matrix production, and the structure of primary cilia. Mitochondrial activity reflects cell health and energy production; bone matrix production indicates the cells' capacity to build the structural components of bone; and primary cilia structure is vital because these are critical cellular antennas. All these remained normal during the testing.

If nicotine and cotinine aren't the primary culprits, what other aspects of cigarette smoke could be damaging bones, and what potential treatments are being explored?

The research highlights that the harmful effects of cigarette smoke extend beyond nicotine alone. The study points to the importance of further research into antioxidants and Nrf2 activation. These could lead to potential treatments to support bone health in smokers and improve fracture recovery by counteracting the effects of oxidative stress.

If I switch to nicotine replacement instead of smoking, am I completely safe from bone health issues, according to this research?

While nicotine replacement therapies may seem like a safer alternative to smoking, the study emphasizes that cigarette smoke has a broader negative impact, particularly regarding oxidative stress. Further research into antioxidants and Nrf2 activation could provide new ways to help smokers maintain stronger bones and recover from fractures more effectively. The long-term impact of nicotine replacement on bone health still needs to be comprehensively evaluated.