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Ophthalmology
Original research
Association of age-related macular degeneration on fracture risks among osteoporosis population: a nationwide population-based cohort study
  1. Chi Chin Sun1,2,3,
  2. Ting-Shuo Huang4,
  3. Tsai-Sheng Fu5,
  4. Chia-Yi Lee6,
  5. Bing-Yu Chen3,
  6. Fang-Ping Chen7
  1. 1Department of Ophthalmology, Chang Gung Memorial Hospital, Keelung, Taiwan
  2. 2School of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan
  3. 3Department of Medical Research and Development, Chang Gung Memorial Hospital, Keelung, Taiwan
  4. 4Department of General Surgery, Chang Gung Memorial Hospital, Keelung, Taiwan
  5. 5Department of Orthopedic Surgery, Chang Gung Memorial Hospital, Keelung, Taiwan
  6. 6Department of Ophthalmology, Show Chwan Memorial Hospital, Changhua, Taiwan
  7. 7Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Keelung, Taiwan
  1. Correspondence to Dr Fang-Ping Chen; fangping{at}cgmh.org.tw

Abstract

Objectives Visual 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).

Design Retrospective analysis of Taiwan’s National Health Insurance Research Database (NHIRD).

Setting A multicenter study conducted in Taiwan.

Participants and controls The 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.

Intervention Patients 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 measures Transitions for OS to spine fracture, OS to hip fracture, OS to humero-radio-ulnar fracture and OS to death.

Results The 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).

Conclusion Patients with OS with AMD had a greater risk of spine and hip fractures than did patients without AMD.

  • ophthalmology
  • epidemiology
  • medical retina
  • bone diseases
  • hip
  • trauma management
http://creativecommons.org/licenses/by-nc/4.0/

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/bmjopen-2020-037028

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    Footnotes

    • Contributors T-SH, F-PC and CCS contributed to the concept and design of the study; CCS-and B-YC contributed to analyses of data. CCS, T-SF and B-YC contributed to interpretation of the data; C-YL, F-PC and CCS contributed to manuscript writing. F-PC had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. All authors included CCS, T-SH, T-SF, C-YL, B-YC and F-PC contributed to the critical revision of the study and the approval of submission.

    • Funding This study was supported by Chang Gung Medical Research Foundation to CCS (CMRPG2D0371, CMRPG2D0372, CMRPG2D0373, CLRPG2G0081, CLRPG2G0082 and CLRPG2G0083).

    • Competing interests None declared.

    • Patient consent for publication Not required.

    • Ethics approval The current study was approved by both the National Health Insurance Administration and the Institutional Review Board of Chang Gung Memorial Hospital, Taiwan.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data availability statement Data are available upon reasonable request. The data used in the current study are available upon reasonable request.