Smoking can affect more than your lungs. If you are recovering from a broken bone, cigarettes can also interfere with the body’s repair process. The good news is that asking for support to stop smoking is a useful step at any point in recovery.

In Statistics Canada’s 2023 Canadian Community Health Survey, 11.4% of adults reported smoking cigarettes daily or occasionally, down from 12.5% in 2022. [1] Although smoking is less common than it once was, its effects on bone health still matter.

Workplace Injuries and Fatalities on Construction Sites

How Dense Are Your Bones?

Bone is living tissue that your body constantly breaks down and rebuilds. Bone mineral density is one measure used to assess bone strength. Smoking is associated with lower bone density and a greater risk of some fractures, particularly as other risk factors accumulate with age.

Genetics, Age and Bone Density

Genes, hormones, nutrition, activity and age all influence bone strength. Bone loss tends to become more noticeable with age and can accelerate after menopause. If you have had a fracture from a minor fall, ask your healthcare provider whether an osteoporosis assessment would be useful.

Smoking Can Increase Surgery and Infection Risks

Some fractures need an operation, and healing involves both the bone and surrounding tissues. Smoking is associated with problems such as slower wound healing and a greater risk of complications. Let your surgical or fracture care team know if you smoke so they can discuss appropriate support before and after treatment.

Smoking Delays Healing

A healing fracture needs a steady supply of oxygen and nutrients. Nicotine can narrow blood vessels and affect the activity of bone-forming cells, while carbon monoxide in cigarette smoke reduces how much oxygen the blood can carry. Together, these effects can make it harder for the body to repair damaged tissue.

In a retrospective review of 1,003 surgically treated tibial fractures, smoking was associated with a longer time to union, although it was not a statistically significant predictor of non-union in that cohort. [2] This distinction matters: the risk varies by fracture type, severity and the individual.

Other risk factors to keep in mind

Diabetes, osteoporosis, long-term corticosteroid use and obesity can also complicate recovery. Someone with several risk factors may need closer follow-up. See our article on osteoporosis-related fractures for more information.

What You Can Do While Your Fracture Heals

  • Tell your doctor or pharmacist if you smoke or vape nicotine.
  • Ask about evidence-based quit support and medicines that may help.
  • Follow your cast, surgery, and rehabilitation instructions.
  • Eat enough protein and bone-supporting nutrients and attend follow-up appointments.
  • Call your care team if pain, swelling or function is unexpectedly getting worse.

If quitting feels difficult, your healthcare team can help you make a practical plan without judgment.

Using Ultrasound Therapy in Fracture Care

Low-intensity pulsed ultrasound (LIPUS) is a non-invasive option sometimes discussed for fractures that are healing slowly. Some observational and earlier studies reported encouraging results, but higher-quality randomized evidence has not shown a consistent benefit for fresh fractures. [3] The decision to use a bone stimulator should be made with your fracture care team rather than replacing standard treatment.

Frequently Asked Questions

Does smoking really slow down bone healing?

It can. Smoking affects blood flow and is associated with longer healing times for certain types of fractures. The exact effect depends on the injury and other health factors.

How does smoking affect blood flow to a fracture?

Nicotine can cause blood vessels to narrow, and carbon monoxide reduces the blood’s oxygen-carrying capacity. Healing cells need good circulation to do their work.

Can quitting smoking help my bone recover?

Stopping smoking can improve your overall health and remove an important exposure that may interfere with healing. Ask your healthcare team about a safe quit plan and the timing of any medications.

What else can delay fracture healing?

Severe injury, infection, unstable fractures, certain medicines and conditions such as diabetes or osteoporosis can affect the process.

What if my fracture is not healing as expected?

Contact your fracture team for reassessment. They may review imaging, health factors and treatment choices before recommending any additional therapy.

Want to understand your at-home support options? Learn about Melmak LIPUS technology and discuss its potential role with your clinician.

References

  1. Statistics Canada. Health behaviours, Health of Canadians report. Daily or occasional smoking, 2022–2023. https://www150.statcan.gc.ca/n1/pub/82-570-x/2024001/section3-eng.htm
  2. Dailey HL, et al. Tibial Fracture Nonunion and Time to Healing After Reamed Intramedullary Nailing. J Orthop Trauma.2018. https://pubmed.ncbi.nlm.nih.gov/29664881/
  3. Schandelmaier S, et al. Low intensity pulsed ultrasound for bone healing. BMJ. 2017. https://pubmed.ncbi.nlm.nih.gov/28348110/