Binocular Visual Field Loss Increases the Risk of Hip and Non–spine, non–hip Fractures

Abstract

Abstract: : Purpose:To determine the relationship between binocular visual field loss and risk for fractures in our prospective Study of Osteoporotic Fractures cohort study of 9,704 older ambulatory Caucasian women who were enrolled without bilateral hip replacement, irrespective of bone mineral density in 1986–8. Methods: We measured a Humphrey 76–point suprathreshold visual field test in each eye among 4,546 Caucasian women (average age: 79.9±4.0 years old) participating in the 6^th clinical exam in 1997–8. Subjects were excluded from this analysis if they did not have visual field tests in both eyes (4.9%) or if their fixation losses on both visual fields were 33% or higher (2.4%). Binocular visual field loss was calculated by overlapping the visual fields from both eyes using Esterman’s binocular field functional scoring algorithm. Participants were contacted every 4 months to ascertain new falls and fractures, and over 98% of these follow–ups were complete. Incident hip and non–spine fractures were physician–adjudicated after review of radiographic reports. Cox proportional hazards regression models, adjusted for age, habitual visual acuity, walking speed, health status, standing up without help, depression, walking for exercise, functional impairments, weight changes, and cognitive function were used to examine the association between binocular visual field loss and fracture. Results: Over a mean (±SD) 3.9 (±0.83) years of follow–up, 140 of 3,802 women (3.7%) without other types of fractures suffered hip fractures and 415 of 4,077 women (10.2%) without hip fractures experienced at least one non–spine, non–hip fracture. Compared to women who did not miss any points on the binocular visual field (n=1,580), women who lost 20 or more points in their binocular visual field (n=442) had a 1.9–fold increase (multivariate RR = 1.92; 95% CI: 1.07, 3.43, p=0.028) in risk for hip fracture and a 1.6–fold increase (multivariate RR = 1.64; 95% CI: 1.17,2.28, p = 0.004) in risk for any non–spine, non–hip fracture. Conclusions: Binocular visual field loss increases the risk of hip and non–spine, non–hip fractures.

Keywords: clinical (human) or epidemiologic studies: risk factor assessment • visual fields