Baron and colleagues1 have conducted a careful case-control study to investigate the relation between cigarette smoking and hip fracture risk among postmenopausal women, but the conclusions reached might be influenced by residual confounding. The authors state in the "Subjects and Methods" section that they collected information about comorbidity, but it is unclear whether the information was detailed enough and whether it was adjusted for in the analyses. This issue is not irrelevant because there seems to be a number of illnesses that have been associated with changes in bone mineral density (BMD) and/or risk of fractures. For example, conditions that are very prevalent among postmenopausal women, such as diabetes mellitus and hypertension, are characterized by an increased bone loss and reduced BMD in women younger or older than 75 years, either premenopausal or postmenopausal.2,3 Furthermore, data about depression could have been interesting given the neurobiological link between smoking and depression,4 the relatively high prevalence of depressive symptoms among patients aged in their 70s and 80s, and the association of major depression with increased bone loss.5
Onder G, Pedone C, Gambassi G. Risk of Hip Fracture in Women: Not Only a Smoking Issue. Arch Intern Med. 2002;162(1):101–102. doi:
Best of JAMA Network 2022
Customize your JAMA Network experience by selecting one or more topics from the list below.