An update on the antiestrogenic effect of smoking: a literature review with implications for researchers and practitioners

Abstract

Objective: To draw attention to the implications of smoking in the pathogenesis of osteoporosis and for the effectiveness and safety of hormone therapy. Design: Summary of own research and a MEDLINE search of English-language literature on the antiestrogenic effect of smoking in pre- and postmenopausal women published during the past two decades. Results: Numerous observations suggest that part of the detrimental effect of smoking on bone metabolism is mediated by an adverse influence on sex-steroid metabolism, and in particular by an estrogen-lowering effect. Furthermore, in smokers, serum concentrations of estradiol and estrone during oral, but not parenteral, hormone therapy (HT) reach only half the concentrations of non- smokers. Thus, cigarette smoking may reduce the favorable effects of HT significantly and may even negate the protective effects. In such cases, the failure of preventive therapy is a failure of dosing rather than of HT per se. Conclusions: We urge colleagues to take the antiestrogenic effect of smoking into account when drawing conclusions from population-based trials, as well as when prescribing HT to their patients for the prevention of menopause-related health problems.