This meta-analysis aimed to quantify the risk of future fractures associated with smoking on an international scale and to explore the relationship between this risk and age, sex, and bone mineral density (BMD). The study included 59,232 participants from ten prospective cohorts, following a total of 250,000 person-years. Current smoking was found to significantly increase the risk of any fracture (RR = 1.25) and osteoporotic fractures (RR = 1.29), with the highest risk observed for hip fractures (RR = 1.84). After adjusting for BMD, the risk ratios remained elevated but were marginally lower. The risk was higher in men than in women for all fractures and osteoporotic fractures but not for hip fractures. Low BMD explained only 23% of the smoking-related risk of hip fractures. The study concluded that a history of smoking significantly increases fracture risk, which is substantial and not fully explained by BMD measurements, making it a valuable risk factor in case-finding strategies.This meta-analysis aimed to quantify the risk of future fractures associated with smoking on an international scale and to explore the relationship between this risk and age, sex, and bone mineral density (BMD). The study included 59,232 participants from ten prospective cohorts, following a total of 250,000 person-years. Current smoking was found to significantly increase the risk of any fracture (RR = 1.25) and osteoporotic fractures (RR = 1.29), with the highest risk observed for hip fractures (RR = 1.84). After adjusting for BMD, the risk ratios remained elevated but were marginally lower. The risk was higher in men than in women for all fractures and osteoporotic fractures but not for hip fractures. Low BMD explained only 23% of the smoking-related risk of hip fractures. The study concluded that a history of smoking significantly increases fracture risk, which is substantial and not fully explained by BMD measurements, making it a valuable risk factor in case-finding strategies.