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June 6, 1977

Smoking Results in Calcitonin Resistance

JAMA. 1977;237(23):2470. doi:10.1001/jama.1977.03270500022008

To the Editor.—  We were interested in the editorial by Hugh H. Hussey (235:1367, 1976) and Daniell's report1 on the relation between smoking and osteoporosis. Our hypothesis for the cause of postmenopausal osteoporosis was recently summarized.2 On the basis of our findings, we think that bone is protected against resorption by an unexplained estrogen effect and by an androgen-dependent calcitonin action. In the absence of virilizing or nonvirilizing androgens, the biologic effect of calcitonin decreases. In our opinion, pathologic postmenopausal osteoporosis occurs in women whose androgen level is low in the biological fluids at the time of cessation of ovarian function and hence, resistance against the bone-protective calcitonin develops.On the basis of Daniell's earlier article,3 we thought that not smoking itself but aminophylline and sympathomimetics used in the treatment of smokers' chronic obstructive lung disease were essentially responsible for the osteoporosis of smokers,4 since these