Abstract
Purpose :
Traditional Chinese medicine considers eye health a key indicator of musculoskeletal well-being. Our previous genome-wide association study (GWAS) linked deep-learning-based retinal aging markers to the IRF4 gene, involved in microglia activation in the retina and macrophage polarization in bones. This study explores the potential of retinal aging stratifying the risk of osteoporosis and bone fracture.
Methods :
In the PopulatION HEalth and Eye Disease PRofilE in Elderly Singaporeans (PIONEER) study, we included 2,659 patients aged 57 to 100 who had retinal images and underwent Dual-energy X-ray Absorptiometry (DXA). After quality control of the retinal images and DXA reports, 694 were excluded. We calculated the average retinal age for both eyes of each participant using the RetiAGE deep-learning algorithm. We extracted osteoporosis-related DXA parameters, such as bone mineral content (BMC), bone mineral density (BMD), and bone size in various regions. We also calculated T-scores and Z-scores- standardized deviations for BMD based on age, gender, ethnicity, and body size. The study adjusted for osteoporosis risk factors (age, gender, calcium intake, diabetes, hypertension, smoking status, physical activity) in its analysis of the association between retinal age and osteoporosis parameters, and assessed the impact of retinal age on the risk of major osteoporotic and hip fractures.
Results :
There were 1,523 and 465 patients with osteopenia and osteoporosis, respectively. In the univariate analysis, BMD and T-scores of the Ward’s, troch, neck and inter regions of the femur, hip, and pelvis were all negatively associated with retinal age after adjusting for multiple testing using the FDR method. (All p<0.001, Figure 1) The associations of the troch, Ward’s and inter regions of the femur and hip with retinal age stayed significant after adjusting for osteoporotic risk factors. (T-score β range from -0.282 to -0.326; p range from 0.022 to 0.034.) The Z-scores in the L2-L4 lumbar vertebra were negatively associated with retinal age. (All p<0.001) The higher retinal age was connected to higher chances of major osteoporotic and hip fractures. (Table 1.)
Conclusions :
This study highlights the risk of osteopenia and osteoporosis in individuals with accelerated retinal biological aging. Elevated retinal age may serve as a warning sign for low BMD and future osteoporotic and hip fractures.
This abstract was presented at the 2024 ARVO Annual Meeting, held in Seattle, WA, May 5-9, 2024.