Association of age-related macular degeneration on fracture risks among osteoporosis population: a nationwide population-based cohort study

Abstract

ObjectivesVisual impairment is an important risk factor for fracture in the elderly population. Age-related macular degeneration (AMD) is the leading cause of irreversible visual impairment in elderly people. This study was conducted to explore the relationship between AMD and incident fractures in patients with osteoporosis (OS).DesignRetrospective analysis of Taiwan’s National Health Insurance Research Database (NHIRD).SettingA multicenter study conducted in Taiwan.Participants and controlsThe current study used the NHIRD in Taiwan between 1996 and 2011. A total of 13 584 and 54 336 patients with OS were enrolled in the AMD group and the non-AMD group, respectively.InterventionPatients with OS were included from the Taiwan’s NHIRD after exclusion, and each patient with AMD was matched for age, sex and comorbidities to four patients with non-AMD OS, who served as the control group. A Cox proportional hazard model was used for the multivariable analysis.Primary outcome measuresTransitions for OS to spine fracture, OS to hip fracture, OS to humero-radio-ulnar fracture and OS to death.ResultsThe risks of spine and hip fractures were significantly higher in the AMD group (HR=1.09, 95% CI=1.04 to 1.15, p<0.001; HR=1.18; 95% CI=1.08 to 1.30, p=0.001, respectively) than in the non-AMD group. The incidence of humero-radio-ulnar fracture between AMD and non-AMD individuals was similar (HR=0.98; 95% CI=0.90 to 1.06; p=0.599). However, the risk of death was higher in patients with OS with older age, male sex and all types of comorbidity (p<0.05), except for hyperthyroidism (p=0.200).ConclusionPatients with OS with AMD had a greater risk of spine and hip fractures than did patients without AMD.

The Association of Erythropoietin and Age-Related Macular Degeneration in Hemodialysis Patients: A Nationwide Population-Based Cohort Study

“…However, the National Health Insurance Bureau of Taiwan maintains a system to conduct regular cross-checking of diagnoses. The claims data have been used in previous studies and have been proven valid, including those for AMD [ 34 , 35 , 36 , 37 , 38 ]. Second, information on education, lifestyle, visual acuity, family history of AMD, and environmental factors, which might potentially contribute to or protect individuals from AMD, were not available in the databases.…”

The prevalence of age-related macular degeneration and osteoporosis in the older Polish population: Is there a link?

“…AMD primarily affects the macula, leading to vision loss in the central 15 to 20 degrees of the visual field, often in both eyes. Not surprisingly, patients with AMD frequently sustain injuries, including skeletal trauma and fragility fractures [ 3 , 4 ]. These fractures may be at least partly associated with (or caused by) age-related bone loss and osteoporosis.…”

“…Clinically, osteoporosis manifests as a higher risk of skeletal fragility and frequently leads to premature mortality. Every third woman and every fifth man over the age of 50 years in developed countries are estimated to experience a bone fracture during their remaining lifetime [ 3 , 9 , 10 ]. Furthermore, a two-fold higher risk of falls was observed in older women with AMD than in those without AMD in a prospective cohort study [ 11 ].…”