Epidemiological association between osteoporosis and combined smoking and use of snuff among South African women

Objectives: This study sought to explore the epidemiological association between the exclusive use and the combined use of snuff and smoking on the prevalence of osteoporosis in a national population sample of South African women who were 40 years and older. Materials and Methods: This study involved a nationally representative sample of South African women who were 40 years and older and took part in the 2003/2004 South African Demographic and Health Survey (n = 2050). Data on tobacco use patterns, dietary calcium intake and other relevant factors were obtained through an interviewer-administered questionnaire. As part of the data collection procedure, participants were asked whether a doctor, a nurse or any other health professional had ever told them they had osteoporosis. Those who answered in the affirmative and/or presented medications for osteoporosis were regarded as having osteoporosis. Results: The prevalence of osteoporosis was higher among those who had ever used both snuff and smoked (17.2%) either in the past or currently than among those who had ever used snuff only (5%) or smoked only (5.1%). Even after controlling for potential confounders in a multivariable-adjusted logistic regression, the combined use of snuff and smoking remained positively associated with osteoporosis (odds ratio = 3.60, 95% confidence interval: 1.03-12.61). However, higher dietary calcium intake was negatively associated with osteoporosis. Conclusions: Based on these findings, it can be concluded that the combined lifetime use of both snuff and cigarettes may increase the odds of developing osteoporosis among women who are 40 years and older.