Visual risk factors for hip fracture in older people

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.