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Visual risk factors for hip fracture in older people
Rebecca Q Ivers1, Robert G Cumming, Paul Mitchell
1Institute for International Health, School of Public Health, Department of Ophthalmology, University of Sydney, PO Box 576, Newtown NSW 2042, Australia. rivers@iih.usyd.edu.au
Objectives:
To determine the association between poor vision and risk of hip fracture in the Blue Mountains Eye Study.
Design:
Prospective population-based cohort study.
Setting:
Two post code areas in the Blue Mountains, west of Sydney, Australia.
Participants:
Three thousand six hundred fifty-four community-dwelling Australians aged 49 and older.
Measurements:
At baseline, subjects had an extensive eye examination, including refraction, contrast sensitivity and visual field testing, photographs of the lens and retina, and an interview. Hip fractures during the 5-year follow-up were identified by self-report and review of medical records and were radiologically confirmed.
Results:
For 2-year follow-up (17 hip fractures), the adjusted hazard ratio (HR) for risk of hip fracture in those with corrected visual acuity worse than 20/60 was 8.4 (95% confidence interval (CI) = 1.5-48.5, population attributable risk (PAR) = 27%); for presence of posterior subcapsular cataract, the adjusted HR was 5.0 (95% CI = 1.1-23.0, PAR = 24%); and for visual field loss, the adjusted HR was 5.5 (95% CI = 1.0-29.8, PAR = 55%). In those aged 75 and older, visual acuity worse than 20/60 gave an adjusted HR of 40.6 (95% CI = 5.6-292.5, PAR = 49%). Visual impairment of any type did not predict risk of hip fracture after a 2-year follow-up.
Conclusion:
Visual impairment is strongly associated with risk of hip fracture in the next 2 years but not over a longer period of time.