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Stacy M Meuer, Kristine E Lee, Barbara E K Klein, Ronald Klein; The relationship of oral bisphosphonates to age-related macular degeneration: The Beaver Dam Eye Study.. Invest. Ophthalmol. Vis. Sci. 2017;58(8):1519. doi: https://doi.org/.
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It was recently suggested there may be a relationship between oral bisphosphonates (BPS), used in the prevention of osteoporotic fractures and age-related macular degeneration (AMD). Oral BPS has been associated with an increased risk of inflammation in the eye, including uveitis and optic neuritis, and it has been thought that this inflammatory response may also be linked to an increased risk of AMD. This study examines the relationship of the intake of BPS to the prevalence and incidence of AMD in older women in a population based study.
As part of the Beaver Dam Eye Study (BDES), 1770 women between the ages of 53 and 100, were examined every five years between 1998 and 2010 (1-3 study visits). Stereo retinal photographs and a detailed medical history including medication usage was collected during each examination. The retinal photographs were evaluated for characteristics of AMD including drusen size, type and area; retinal pigmentary abnormalities (PA); geographic atrophy (GA); and exudative lesions. Early AMD was defined as the presence of PA with any drusen present, or large soft drusen involving a large retinal area. Late AMD included the presence of GA and/or exudative lesions. Use of oral BPS including alendronate (Fosamax), ibandronate (Boniva) and risedronate (Actonel) was recorded.
There were 248 out of 1770 women taking oral BPS at one or more study visits for a total of 333 drug exposure visits and 3645 study visits with no drug exposure. Of those women taking oral BPS 15/333 (4.5%) visits had late AMD, whereas 140/3645 (3.8%) of those not taking oral BPS had late AMD (P=0.59). After adjusting for age these results were still not statistically significantly different (P=0.79). The results were similar for prevalence of early AMD (P=0.99) as well as for the individual AMD lesions. Incidence of early or late AMD was not associated with the use of oral BPS (P=0.95 and P=0.80 respectively, after controlling for age).
After adjusting for age, in the BDES, women taking oral BPS were no more likely to have prevalent or incident early or late AMD, than women not taking these drugs. This contradicts a recent finding of an association of late AMD in women taking oral BPS compared to those not taking this drug. Combining results from other epidemiologic studies to increase power may help to clarify the risk of oral bisphosphonates and AMD.
This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.
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