Abstract
OBJECTIVES:
The aim of this study was to evaluate whether nontobacco nicotine dependence (NTND) in adolescents and young adults is associated with an increased risk of new-onset fractures over a medium-term and long-term follow-up.
METHODS:
Design:
retrospective cohort query of TriNetX network.
Setting:
Multicenter study conducted using deidentified electronic health records from the TriNetX network of participating health care organizations.
Patient Selection Criteria:
Adolescents and young adults (≤21 years) were included if they had a diagnosis of NTND between June 1, 2005, and June 1, 2020. Exclusions: any previous tobacco use, environmental tobacco exposure, tobacco use disorder, preexisting bone/joint pathology (eg, osteoporosis, osteoarthritis, osteogenesis imperfecta, and malignant neoplasms of bone/cartilage), or previous fracture. Patients with NTND were propensity score matched 1:1 with controls without any documented nicotine or tobacco use.
Outcome Measures and Comparisons:
The primary outcome was incident fracture after the most recent eligible clinical encounter documented between June 1, 2005, and June 1, 2020. Fracture risk was assessed over a fixed 5-year period after the index date and across the longest available follow-up in TriNetX. Risk ratios (RR) and 95% confidence intervals (CI) were calculated. Kaplan–Meier survival analysis was used to estimate hazard ratios (HR) for time-to-event comparison.
RESULTS:
The matched cohort was comprised of 10,576 patients per group with an average age at index of 19.4 ± 1.7 years. The NTND group was comprised of 44.9% males and 54.7% females, whereas the control group was comprised of 44.7% males and 55.0% females. At 5 years, fracture incidence was 1.1% in the NTND group and 0.5% in controls (RR, 2.1; 95% CI, 1.5–2.9;
P
P
CONCLUSIONS:
Nontobacco nicotine dependence was associated with a two-fold increased risk of fracture among adolescents and young adults (RR, 2.1; 95% CI, 1.5–2.9 at 5 years; RR, 1.9; 1.5–2.4 over an extended follow-up period). It is suggested by these findings that skeletal health consequences should be considered when evaluating the long-term effect of nicotine use in youth.
LEVEL OF EVIDENCE:
Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.