Visual field loss and risk of fractures in older women.
OBJECTIVE
To evaluate the associations between visual field loss and nonspine fractures.


METHODS
Prospective cohort study.


METHODS
Community.


METHODS
Four thousand seven hundred seventy-three community-dwelling white and African-American women aged 65 and older with no previous history of hip fracture at the time of recruitment.


METHODS
Radiographically confirmed hip and nonspine, nonhip fractures identified from September 1997 to April 2008. Visual field loss was measured using a Humphrey Field Analyzer suprathreshold screening test of the peripheral and central vision of each eye and was classified into an ordinal rating of no, mild, moderate, or severe binocular visual field (BVF) loss.


RESULTS
For hip and nonspine, nonhip fractures and in unadjusted and covariate-adjusted analyses, the highest incidence of fractures was seen in women with the most-severe BVF loss. In covariate-adjusted analysis, women with mild, moderate, and severe BVF loss had a 49% (hazard ratio (HR)=1.49, 95% confidence interval (CI)=1.18-1.88), 25% (HR=1.25, 95% CI=0.87-1.80), and 66% (HR=1.66, 95% CI=1.19-2.32) greater risk, respectively, for hip fractures than women without BVF loss. Similarly, women with mild visual field loss had a 12% (HR=0.88, 95% CI=0.75-1.04) lower risk for nonspine, nonhip fractures, whereas women with moderate and severe visual field loss had a 18% (HR=1.18, 95% CI=0.92-1.52) and 59% (HR=1.59, 95% CI=1.24-2.03) greater risk of nonspine, nonhip fractures than women without BVF loss.


CONCLUSIONS
BVF loss is independently associated with hip and nonspine, nonhip fractures in older female volunteers.
Coleman
Anne L
AL
Jules Stein Eye Institute, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California, USA. coleman@jsei.ucla.edu
Cummings
Steven R
SR
Ensrud
Kristine E
KE
Yu
Fei
F
Gutierrez
Peter
P
Stone
Katie L
KL
Cauley
Jane A
JA
Pedula
Kathryn L
KL
Hochberg
Marc C
MC
Mangione
Carol M
CM
D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D050723:Fractures, Bone / Q000150:complications* / Q000453:epidemiology*; D006801:Humans; D011446:Prospective Studies; D012307:Risk Factors; D014786:Vision Disorders / Q000150:complications* / Q000453:epidemiology*; D014794:Visual Fields
Br J Ophthalmol. 2004 Sep;88(9):1191-6
15317714
Am J Ophthalmol. 2004 Mar;137(3):420-5
15013863
Arch Ophthalmol. 2001 Dec;119(12):1788-94
11735788
Trans Am Ophthalmol Soc. 2007;105:312-29
18427619
Lancet. 1999 Nov 20;354(9192):1803-10
10577657
Lancet. 1996 Jul 20;348(9021):145-9
8684153
Ophthalmology. 1982 Nov;89(11):1226-34
7155532
Am J Epidemiol. 1992 Mar 1;135(5):490-9
1570815
JAMA. 1990 Feb 2;263(5):665-8
2404146
JAMA. 2005 May 4;293(17):2102-8
15870413
N Engl J Med. 1995 Mar 23;332(12):767-73
7862179
Arch Ophthalmol. 1993 Jan;111(1):56-61
8424725
Ophthalmology. 2003 May;110(5):900-7
12750087
Am J Ophthalmol. 2006 Dec;142(6):1081-3
17157603
JAMA. 1991 Jul 17;266(3):369-74
2056646
Osteoporos Int. 2002;13(6):513-8
12107667
J Glaucoma. 2003 Apr;12(2):134-8
12671468
J Am Geriatr Soc. 2007 Mar;55(3):357-64
17341237
N Engl J Med. 1991 May 9;324(19):1326-31
2017229
Ophthalmology. 1998 Jan;105(1):160-4
9442793
Ophthalmology. 1996 Jun;103(6):907-17
8643246
Am J Ophthalmol. 2000 Dec;130(6):813-20
11124302
Am J Optom Physiol Opt. 1976 Nov;53(11):740-5
998716
Graefes Arch Clin Exp Ophthalmol. 2005 Mar;243(3):210-6
15806374
Bull World Health Organ. 2004 Nov;82(11):844-51
15640920
Am J Ophthalmol. 2001 Jul;132(1):41-6
11438052
Ophthalmology. 1986 Mar;93(3):371-8
3703506
Invest Ophthalmol Vis Sci. 1997 Feb;38(2):469-77
9040480
Am J Epidemiol. 1992 Mar 1;135(5):477-89
1570814
Am J Ophthalmol. 1997 Mar;123(3):328-37
9063242
Ophthalmology. 2004 Aug;111(8):1439-48
15288969
J Am Geriatr Soc. 2003 Mar;51(3):356-63
12588579