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most significantly with tobacco product or wrapped in the leaf of piper betel nut.[2,9,18,19] Incorporation of lime (chuna or chunam in India)and tobacco to the nut demonstrate increased incidence of mucosal changes.[20] Some of the terminological confusion surrounding the subject possibly resides in the fact that the nut (areca nut) component of betel mixture is the fruit of betel tree (palm), while betel leaf and other constituents derived from different plant called betel vine.[8] Blank et al

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21 examined the NHANES data from 2005 to 2010, 2013 to 2014, and 2017 to 2018 and obtained 10564 individuals defined as osteoporosis or osteopenia based on bone mineral density, concluding that smoking was associated with a higher prevalence of osteoporosis than non-smoking

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