Stay vigilant during transition to endemic as a change in lifestyle through the last two years may have repercussions for bone health.

KUALA LUMPUR, May 31 (Bernama) --  In conjunction with World No Tobacco Day on 31 May, Bone Health Alliance Malaysia (BHAM) supports the Malaysian government's call for action towards effective tobacco control measures as it is critical to improving bone health and reducing the burden of fractures.
 
The past two years have greatly affected the prevention and care of chronic diseases, especially for silent diseases such as osteoporosis. While there are no conclusive data available yet, early reports suggest that the stress and anxiety of the pandemic in the last few years has caused an increased dependence on substances such as tobacco. [1] and an increase in smoking among those trying to quit[2].
 
Smoking can decrease bone density and increase the risk of fracture [3], almost doubling the risk of hip fracture compared to non-smokers [4]. If you currently smoke or used to smoke, you are encouraged to ask your healthcare provider if you are a suitable candidate for a bone mineral density test, which can help determine if osteoporosis treatment or medication should be considered.
 
“Tobacco consumption in any form has a series of negative repercussions on health [5]. While increased risk of cancer and cardiovascular disease is the most talked about, we tend to overlook the ill effect of smoking on the bones. Meanwhile, smoking cessation is observed to reverse the effect of smoking and improve bone health⁵. We urge members of the public to speak to their healthcare provider to seek information on their options to quit smoking,” said Assoc. Prof. Dr. Jeyakantha Ratnasingam, Consultant Endocrinologist & Secretary of Malaysian Osteoporosis Society (MOS).
 
“Smoking interferes with calcium and vitamin D absorption in the body and has also been shown to have a negative impact on bone healing after fracture [6]. According to a recent meta-analysis acknowledged by WHO, approximately 19% of all hip fractures were attributed to cigarette smoking⁶. The best thing smokers can do to protect their bones is to quit smoking. Smoking cessation, even later in life, may help limit smoking-related bone loss⁶,” added Dato’ Dr. Lee Joon Kiong, Consultant Orthopaedic Surgeon & President of Fragility Fracture Network Malaysia (FFNM).
 
“Smoking during the years of bone-building, such as adolescence, puts a person at risk of osteoporosis later in life[7]. Smoking after 30 will speed up loss of bone mass by almost twice as fast⁷. The entire body will lose bone mass, but the hip, spine, and wrist are generally the most affected areas⁷. The shocking part is that inhaling second-hand smoke affects one's bones in the same way^7{C}{C}. Quitting smoking is essential, but beyond that, speak to your doctor to learn more about how to strengthen your bones through lifestyle measures and appropriate treatment,” advised Assoc. Prof. Dr. Tan Kit Mun, Consultant Geriatrician & Vice-President of Osteoporosis Awareness Society of Kuala Lumpur and Selangor (OASKLS). 

Here are some quick tips to take note of:
· Visit your doctor for a check-up to be aware of your current bone health and make informed decisions.
· While a temporary delay in osteoporosis medication may not have a long-term effect on a patient’s bone health, you should contact your HCP and reschedule as soon as possible. 

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