Sun Chi Chin, Huang Ting-Shuo, Fu Tsai-Sheng, Lee Chia-Yi, Chen Bing-Yu, Chen Fang-Ping
Department of Ophthalmology, Chang Gung Memorial Hospital, Keelung, Taiwan.
School of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan.
BMJ Open. 2020 Sep 17;10(9):e037028. doi: 10.1136/bmjopen-2020-037028.
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).
Retrospective analysis of Taiwan's National Health Insurance Research Database (NHIRD).
A multicenter study conducted in Taiwan.
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.
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.
Transitions for OS to spine fracture, OS to hip fracture, OS to humero-radio-ulnar fracture and OS to death.
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).
Patients with OS with AMD had a greater risk of spine and hip fractures than did patients without AMD.
视力损害是老年人群骨折的一个重要危险因素。年龄相关性黄斑变性（AMD）是老年人不可逆视力损害的主要原因。本研究旨在探讨AMD与骨质疏松症（OS）患者发生骨折之间的关系。
对台湾国民健康保险研究数据库（NHIRD）进行回顾性分析。
在台湾进行的一项多中心研究。
本研究使用了1996年至2011年间台湾的NHIRD。AMD组和非AMD组分别纳入了13584例和54336例OS患者。
排除后从台湾NHIRD中纳入OS患者，每例AMD患者按年龄、性别和合并症与4例非AMD的OS患者匹配，后者作为对照组。采用Cox比例风险模型进行多变量分析。
OS转变为脊柱骨折、OS转变为髋部骨折、OS转变为肱桡尺骨骨折以及OS导致死亡。
AMD组脊柱和髋部骨折的风险显著高于非AMD组（HR = 1.09，95%CI = 1.04至1.15，p < 0.001；HR = 1.18；95%CI = 1.08至1.30，p = 0.001）。AMD个体与非AMD个体之间肱桡尺骨骨折的发生率相似（HR = 0.98；95%CI = 0.90至1.06；p = 0.599）。然而，年龄较大、男性以及患有所有类型合并症（除甲状腺功能亢进外，p = 0.200）的OS患者死亡风险更高（p < 0.05）。
患有AMD的OS患者比未患有AMD的患者发生脊柱和髋部骨折的风险更高。
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