Overall, smokers are 2.3 times likelier to have long bones that do not heal properly after a fracture, according to new research. Long bones are classified as bones that are longer than they are wide.

Researchers presented an analysis of data from 20 studies on smoking and the healing of fractures at the 2013 Annual Meeting of the American Academy of Orthopaedic Surgeons (AAOS).

The analysis also found that the average time to fracture healing was longer for smokers (32 weeks) than nonsmokers (25.1 weeks). The authors recommended that the topic be discussed with patients at the time of injury and when considering surgery.

More than one in four Americans have bone or joint health problems, making them the greatest cause of lost work days in the U.S., according to the AAOS.