The study found smoking has the greatest effect on the quality of bone in the hips and the lumbar, or lower, spine. Both areas are common sites for fracture in older women who have osteoporosis.
During the study, the girls received annual clinical exams over the course of three years. During each visit, doctors screened the girls with dual energy x-ray absorptiometry, a test that measures total bone mineral content as well as the bone mineral density of the hip and lumbar spine. Physicians also screened the teens for depression and anxiety. Every three months, the girls' smoking levels were assessed during phone interviews.