Dr Sarah Jarvis answers your health questions this month Is vaping safer?

Q I have been trying to persuade my husband to stop smoking for years. He’s finally switched to e-cigarettes, but shows no sign of stopping completely. Is it safe for him to use them long term or should I keep pushing?

AI’m delighted that your husband has stopped smoking normal cigarettes, and he’s by no means alone in switching to e-cigarettes. Their use has taken off in the past decade, with more than 2.3 million users last year in the UK. Half of these used vaping as a way to stop smoking. And there’s no question that they have contributed to the welcome fall in the country’s smoking rates – down to 17% (of adults).

A review of the scientific evidence by Public Health England in 2015 suggested that e-cigarettes are ‘95% less harmful than tobacco’. There is no long-term data, but apart from nicotine, e-cigarettes don’t have the toxins and chemicals – including formaldehyde, hydrogen cyanide, arsenic and ammonia – found in normal cigarettes. With usual use, e-cigarettes don’t pose a risk of nicotine poisoning and there’s no evidence of any risk of passive smoking. NICE (the National Institute for Health and Care Excellence) has also looked at the issue of reducing tobacco-related harm. Its most recent guidance focused on ‘harm-reduction approaches to smoking’ and gave advice on long-term use of alternatives to cigarettes. It also makes the point that it’s reasonable to assume using licensed nicotine-containing products, even lifelong, will be considerably less harmful than smoking.

E-cigarettes also, of course, don’t contain tar – and as a lung-physician colleague of mine once put it, ‘People smoke for the nicotine – they die from the tar.’ Nicotine is highly addictive, but it’s tar that really does the damage, leading to the chronic lung disease COPD and cancer of the lungs, digestive tract, kidney, bladder, liver and pancreas (among others).

There are still some concerns about e-cigarettes normalising or even glamorising smoking, and that users may be more likely to start smoking normal cigarettes again. So I can’t reassure you completely, but I would suggest a grown-up conversation with your other half so he has all of the facts. Q Both my aunts have osteoporosis and I want to avoid the same fate. My GP says I don’t qualify for a bone-density check. What can I do?

AYou’re right to be concerned – a family history does count as a risk factor, but more attention is paid if it’s a ‘first-degree’ relative (parent, sibling or child) or if a relative has broken a hip. Other potential risk factors include premature menopause (under 45), being very immobile or underweight, smoking, high alcohol intake, regular use of highdose steroid medicines, rheumatoid arthritis, or bowel conditions like coeliac disease and Crohn’s disease.

Your bones start to thin from your 40s, and this speeds up after the menopause. Exercising regularly (it needs to be weight-bearing, so pretty much anything except swimming or cycling), increasing calcium and vitamin D intake, and keeping alcohol intake down will all protect you. People above a certain age who fulfil certain high-risk criteria are eligible for DEXA screening – a painless test for bone density. Otherwise, you can buy an at-home test called Osentia (£39.99), which has good evidence for accuracy, from high street pharmacies.