Association between electronic cigarette use and fragility fractures among US adults

•The prevalence of fragility fractures was higher among individuals who had ever used electronic cigarettes.•Former and current electronic cigarette users had a higher prevalence of fragility fractures compared to never users.•There was a graded increase in the prevalence of fragility fractures among sole conventional cigarette smokers and dual users of traditional and e-cigarettes.•Electronic cigarette use may be detrimental to bone health. The popularity of electronic cigarette (e-cigarette) use continues to rise in the United States. While conventional cigarette smoking is an established risk factor for osteoporosis and osteoporotic fracture, the effects of e-cigarette use on bone health are unknown. We aimed to examine the association between e-cigarette use and fragility fractures. We pooled 2017–2018 data from the National Health and Nutrition Examination Survey (NHANES). We included men and women with complete information on key variables. E-cigarette use was categorized as either never or ever users. Ever users were further classified as former and current users. Fragility fracture was defined as a composite of self-reported fracture of the hip, spine or wrist which resulted from minimal trauma such as a fall from standing height or less. Of 5569 participants, there were 4519 (81.2%) never e-cigarette users, 1050 (18.8%) ever e-cigarette users, and 444 (8.0%) with self-reported fragility fracture. In adjusted models, ever e-cigarette users had a 46% higher prevalence of self-reported fragility fractures compared to never users (aPR: 1.46, 95% CI: 1.12, 1.89). We also observed a higher prevalence of fragility fractures among former and current e-cigarette users compared to never users (aPR: 1.89, 95% CI: 1.44, 2.48 and aPR: 1.77, 95% CI: 1.04, 3.02 respectively). E-cigarette use was associated with a higher prevalence of self-reported fragility fracture. These findings suggest that e-cigarette use may be harmful to bone health. These data highlight the critical need for longitudinal studies exploring the potential effect(s) of e-cigarette use on bone health.