Quick Answer: Smoking and bone healing do not mix. Nicotine and other chemicals in tobacco reduce blood flow and oxygen to bone, which can slow fracture healing and raise the risk of problems after surgery. Quitting, even a few weeks before a planned surgery, can improve your recovery.
If you have a broken bone or an upcoming orthopedic surgery, one of the most powerful things you can do for your recovery has nothing to do with the operating room. It is quitting smoking. The link between smoking and bone healing is well established, and it affects everything from a simple wrist fracture to a joint replacement.
November is a good time to make a plan. The American Cancer Society's Great American Smokeout falls on Thursday, November 19, 2026. It is a day to quit, or to start a plan to quit. Here is what smoking and vaping do to your bones, and how quitting helps.
How Smoking Affects Bone Healing
Bone is living tissue. To heal, it needs a steady supply of blood, oxygen, and nutrients. Smoking interferes with all three.
Less Blood Flow
Nicotine narrows blood vessels. That means less blood reaches the injured bone and the tissue around it. Healing cells cannot do their job well without a good blood supply.
Less Oxygen
Cigarette smoke contains carbon monoxide. Carbon monoxide attaches to red blood cells in place of oxygen. Your bones and soft tissues get less oxygen as a result, which slows repair.
Slower Bone-Building Cells
Research summarized by the American Academy of Orthopaedic Surgeons (AAOS) shows that tobacco use slows the cells that build new bone. That is why people who smoke often take longer to heal a fracture.
Smoking also affects bones before an injury ever happens. The U.S. Surgeon General's 2004 report on the health effects of smoking concluded that smoking causes lower bone density in older women and raises the risk of hip fracture. Weaker bones break more easily and can be harder to fix.
Smoking and Bone Healing After Fractures and Surgery
The effects of smoking show up in several ways after an injury or operation.
Delayed Healing and Nonunion
A nonunion is a broken bone that does not heal. Smoking is one of the best-known risk factors for slow healing and nonunion. A bone that does not heal may need another surgery, such as a bone graft. Our fractures and trauma page explains how we treat broken bones.
Wound Problems and Infection
Poor blood flow to the skin makes incisions slower to close. People who smoke have a higher risk of wound problems and infection after surgery. In orthopedics, an infection near a plate, screw, or implant can be serious and hard to treat.
Joint Replacement and Foot Surgery
Smoking raises the risk of complications after joint replacement surgery, including infection and wound healing problems. It also matters in foot and ankle surgery, where the blood supply is already limited, and in healing a broken foot. Procedures that rely on bones fusing together, such as a joint fusion, are especially affected. Many surgeons ask patients to stop smoking before these surgeries.
What About Vaping and Nicotine Products?
Many people switch to e-cigarettes, pouches, or gum and assume their bones are safe. Vapes do not create carbon monoxide the way burning tobacco does, but most still contain nicotine. Nicotine itself narrows blood vessels. Research on vaping and bone healing is still new, so many surgeons treat any nicotine use as a risk before surgery. Be honest with your care team about every product you use so they can give you the right advice.
Planning Ahead for Orthopedic Surgery
If you are thinking about a planned surgery, such as a knee or hip replacement or a bunion correction, the best time to quit smoking is now. Many orthopedic surgeons ask patients to be nicotine free for several weeks before surgery and to stay that way while the bone and wound heal.
Some surgeons may use a simple urine or blood test to check for nicotine before certain surgeries. This is not meant to punish anyone. It helps the care team plan the safest surgery for you. In some cases, a surgeon may suggest waiting to have an elective surgery until you have quit.
Be open with your surgeon. Tell them if you smoke, vape, chew tobacco, or use nicotine pouches, and how much. Also tell them if you have tried to quit before. Your care team can work with your primary care doctor to find a quit plan that fits you. Even cutting back is a step in the right direction, but quitting completely gives your bones the best chance to heal.
Smoking is not the only factor in healing. Diabetes, poor nutrition, low vitamin D, and some medicines can also slow bone repair. Your surgeon will look at your overall health and help you get ready for surgery in every way possible.
How Quitting Helps You Heal
The good news is that your body starts to recover quickly after you quit. Carbon monoxide levels in the blood drop within a day or so. Blood flow begins to improve over the following weeks.
Your bones benefit in the long run too. Over months and years, quitting helps protect bone density and lowers the risk of future fractures. It also lowers your risk of heart disease, lung disease, and many cancers, which can make any future surgery safer.
The World Health Organization has reported that people who stop smoking about four weeks or more before surgery have a lower risk of complications. The longer you stay smoke-free, the greater the benefit. Quitting after an injury still helps your fracture heal, even if surgery is not needed.
Tips for Quitting
Pick a quit date. The Great American Smokeout on November 19 is a good choice. Tell your family and friends so they can support you.
Talk with your primary care doctor about medicines that reduce cravings. According to the Centers for Disease Control and Prevention (CDC), quit-smoking medicines and counseling can greatly improve your chances of quitting for good. If you are having surgery, ask your surgeon which options are safe for you.
Get free coaching. Call 1-800-QUIT-NOW to reach free quit-smoking support in your state.
Plan for triggers. Coffee, stress, and being around other smokers can bring on cravings. Have a plan, such as a short walk, chewing gum, or calling a friend.
Stay Smoke-Free During Recovery
Quitting before surgery helps, but staying smoke-free afterward matters just as much. Bone keeps healing for months after a fracture or surgery. Going back to cigarettes or vaping during that time can slow the final stages of healing. If you slip, do not give up. Talk with your doctor or quit coach and set a new quit date.
Support Healing in Other Ways
Eat regular meals with enough protein, fruits, and vegetables. Get enough calcium and vitamin D. Limit alcohol, which can also slow bone healing and raise fall risk. Follow your activity and weight-bearing instructions closely.
Conclusion
Smoking and bone healing are closely linked. Tobacco and nicotine slow fracture repair, raise the risk of infection, and can affect the results of orthopedic surgery. Quitting is one of the best steps you can take for a faster, safer recovery. If you have a fracture or are planning surgery, talk with your orthopedic surgeon about a plan. Our Pomona office cares for patients from Claremont, La Verne, Montclair, and across the Inland Empire.
If you're experiencing slow healing after a fracture or orthopedic surgery, the team at Garey Orthopedic Medical Group is here to help. We offer same-day and next-day appointments for new patients. Visit gareyortho.com or call us to schedule today.