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RESEARCH PAPER
Smoking shapes the relationship between metabolic biomarkers and femoral-neck bone mineral density: A stratified analysis by smoking status
1
Department of Biomedical
Sciences, College of Health
Sciences, QU Health, Qatar
University, Doha, Qatar
2
University of Birmingham
Medical School, Birmingham,
United Kingdom
3
Department of Public
Health, College of Health
Sciences, QU Health, Qatar
University, Doha, Qatar
Submission date: 2025-10-03
Final revision date: 2025-12-20
Acceptance date: 2026-04-22
Publication date: 2026-08-01
Corresponding author
Atiyeh M. Abdallah
Department of Biomedical Sciences, College of Health Sciences, QU Health, Qatar University, Doha, Qatar
Department of Biomedical Sciences, College of Health Sciences, QU Health, Qatar University, Doha, Qatar
Tob. Induc. Dis. 2026;24(August):139
KEYWORDS
TOPICS
ABSTRACT
Introduction:
Bone mineral density (BMD) is a crucial indicator of bone strength and osteoporosis risk. Smoking is known to negatively impact bone health and related bone metabolism biomarkers. However, if and how smoking status influences the relationship between bone metabolism biomarkers and BMD, particularly measured at the femoral neck, remains poorly understood. The objective of this study was to examine the relationship between bone metabolism biomarkers and BMD stratified by smoking status.
Methods:
Data from 4464 healthy individuals were collected from the Qatar Biobank. The sample was divided into smokers, non-smokers, and ex-smokers, and logistic regression was used to examine relationships between biochemical markers and femoral-neck BMD in the different subgroups.
Results:
Sex, age, and body mass index consistently influenced BMD across all smoking strata. Males and older individuals were at higher risk of low BMD, while higher BMI was protective. Creatinine levels were positively associated with BMD in all groups. Alkaline phosphate (ALP) was significantly associated with BMD in non-smokers and ex-smokers but not in smokers, while cholesterol levels were negatively associated with BMD in non-smokers and smokers but not in ex-smokers.
Conclusions:
Smoking status impacts the relationship between metabolism-related biomarkers and BMD, highlighting the need for smoking status-specific bone health guidelines. These findings emphasize the importance of including smoking history in clinical bone health assessments and suggest that personalized approaches may be necessary to mitigate the risk of bone deterioration.
Bone mineral density (BMD) is a crucial indicator of bone strength and osteoporosis risk. Smoking is known to negatively impact bone health and related bone metabolism biomarkers. However, if and how smoking status influences the relationship between bone metabolism biomarkers and BMD, particularly measured at the femoral neck, remains poorly understood. The objective of this study was to examine the relationship between bone metabolism biomarkers and BMD stratified by smoking status.
Methods:
Data from 4464 healthy individuals were collected from the Qatar Biobank. The sample was divided into smokers, non-smokers, and ex-smokers, and logistic regression was used to examine relationships between biochemical markers and femoral-neck BMD in the different subgroups.
Results:
Sex, age, and body mass index consistently influenced BMD across all smoking strata. Males and older individuals were at higher risk of low BMD, while higher BMI was protective. Creatinine levels were positively associated with BMD in all groups. Alkaline phosphate (ALP) was significantly associated with BMD in non-smokers and ex-smokers but not in smokers, while cholesterol levels were negatively associated with BMD in non-smokers and smokers but not in ex-smokers.
Conclusions:
Smoking status impacts the relationship between metabolism-related biomarkers and BMD, highlighting the need for smoking status-specific bone health guidelines. These findings emphasize the importance of including smoking history in clinical bone health assessments and suggest that personalized approaches may be necessary to mitigate the risk of bone deterioration.
CONFLICTS OF INTEREST
The authors have completed and submitted the ICMJE Form for
Disclosure of Potential Conflicts of Interest and none was reported.
FUNDING
This research was supported by Qatar University, internal grants
No. QUCG-CHS-25/26-736, QUST-1-CHS-2025-212 and QUST-1-
CHS2025-245.
Qatar National Library funded the publication cost for this article. The findings presented herein are solely the responsibility
of the authors.
ETHICAL APPROVAL AND INFORMED CONSENT
Ethical approval was obtained from the Qatar Biobank (Approval number: E-2021-QF-QBB-RES-ACC-00050-0172; Date: renewal 23 September 2025) and the Qatar University (Approval number: QU-IRB 1648-E/22; Date: 19 January 2022). Participants provided informed consent.
DATA AVAILABILITY
The data supporting this research are available from the following
source: Qatar Biobank https://www.qphi.org.qa/.
AUTHORS' CONTRIBUTIONS
All authors have directly participated in the planning, execution, or
analysis of this study. All authors have read and approved the final
version of the manuscript.
PROVENANCE AND PEER REVIEW
Not commissioned; externally peer reviewed.
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