Bone Mineral Density and Age-Related Maculopathy in Older Women

The risk of fracture in age-related macular degeneration according to the presence of visual disability: a nationwide cohort study

PURPOSE

To evaluate the association between age-related macular degeneration (AMD) with or without visual disability (VD) and the risk of fracture using the National Health Insurance data in South Korea.

METHODS

In total, 3,894,702 individuals who had taken part in health-screening programs between January 1, 2009, and December 31, 2009, were included in the cohort and followed until December 31, 2019. The participants with VD, which could be related to the severity of AMD, were defined as those with a loss of vision or visual field defect as certified by the Korean government's Ministry of Health and Welfare. The hazard ratio was calculated for groups (control and AMD with/without VD) using the multivariable-adjusted cox regression analysis.

RESULTS

In total, 466,890 participants (11.99%) were diagnosed with fractures during the study period. An increased risk of fracture was observed in individuals with AMD compared with the control (adjusted hazard ratio (aHR), 1.09, 95% confidence interval (CI), 1.06-1.11). Furthermore, among the AMD individuals, an increased risk of fracture was prominent in individuals with VD (aHR 1.17, 95% CI 1.08-1.27) than those without VD (aHR 1.08, 95% CI 1.06-1.11) compared with the reference group (control).

CONCLUSIONS

AMD was associated with an increased risk of fracture even without VD. Prevention for fracture should be considered in AMD patients, especially when accompanied by VD.

The prevalence of age-related macular degeneration and osteoporosis in the older Polish population: Is there a link?

BACKGROUND

Age-related macular degeneration is the primary cause of irreversible blindness in developed countries, whereas the global prevalence of osteoporosis-a major public health problem-is 19.7%. Both diseases may coincide in populations aged >50 years, leading to serious health deterioration and decreased quality of life.

OBJECTIVES

This study aimed to analyze the relationship between age-related macular degeneration and osteopenia, defined as decreased bone mineral density, in the Polish population.

METHODS

Participants were derived from the population-based Bialystok PLUS Study. Randomized individuals were stratified into two groups, those with age-related macular degeneration (AMD-1 group) or without age-related macular degeneration (AMD-0 group). Using a cutoff value of -1.0 to identify low bone mass, participants with femoral bone mineral density T-scores above -1.0 were assigned to the normal reference, and those with T-scores below -1.0 were assigned to the osteopenia category. Among 436 Caucasian participants aged 50-80 years (252 women, 184 men), the prevalence of age-related macular degeneration was 9.9% in women and 12.0% in men. Decreased bone mineral density based on T-scores was observed in 36.9% of women and in 18.9% of men. Significant differences in femoral bone mineral density between the AMD-0 and AMD-1 groups were detected only in men (mean difference [95% confidence interval] = 0.11 (0.02; 0.13); p = 0.012 for femoral bone mineral density, and 0.73 [0.015; 0.94]; p = 0.011 for the femoral T-score). No associations were observed between bone mineral density and age-related macular degeneration in women.

CONCLUSION

Decreased femoral bone mineral density may be associated with a higher risk of age-related macular degeneration in men, but a causal link remains unclear.

Choroidal Thickness in Relation to Bone Mineral Density with Swept-Source Optical Coherence Tomography

Purpose

To assess whether bone mineral density, indicated by the lumbar X-ray scan, is related to changes in choroid thickness in normal subjects.

Methods

This study included 355 patients with decreased bone mineral density and 355 age- and sex-matched healthy subjects. Lumbar BMD was measured by dual-energy X-ray absorptiometry (DXA). Choroidal thickness was measured using swept-source optical coherence tomography (SS-OCT). Blood pressure (BP), cholesterol, triglyceride (TG), high-density lipoprotein (HDL), and low-density lipoprotein (LDL) were recorded on the same day.

Results

There was a significant difference in average choroidal thickness between low BMD subjects and normal subjects (p=0.003). The BP, cholesterol, triglyceride, HDL, and LDL showed no significant difference between the two groups. The correlations showed that average choroidal thicknesses were associated with BMD in the entire population (r = 0.125, p=0.001).

Conclusion

The choroidal thickness is thinner in low BMD populations compared with normal individuals. There is a strong positive correlation of choroidal thickness with BMD, regardless of age, sex, and other demographic and clinical factors.

Association Between Osteoporosis and Age-Related Macular Degeneration: The Korea National Health and Nutrition Examination Survey

Purpose

Previous studies have reported a possible link between low bone mineral density and AMD. The aim of the present study was to investigate the association between osteoporosis and AMD in a South Korean cohort.

Methods

This cross-sectional, nationwide study included 3496 women and 2789 men who had participated in the Korean National Health and Nutrition Examination Survey from 2008 to 2011. All retinal photographs were graded using an international classification and grading system. Osteoporosis was assessed using dual-energy x-ray absorptiometry. Multivariate logistic regression analysis was performed to examine the relationship between osteoporosis and AMD after adjustment for potential confounders, including age, the body mass index, dietary calcium intake, and the serum vitamin D level. The odds ratios (OR) for other aging-related eye diseases, including cataract, open-angle glaucoma, and diabetic retinopathy, were analyzed in accordance with the presence of osteoporosis.

Results

Multivariate regression analysis revealed that osteoporosis was significantly associated with all types of AMD (early and late: OR, 1.31; P = 0.017) and early AMD (OR, 1.36; P = 0.007) in women. Late AMD was not associated with osteoporosis (OR, 0.84; P = 0.670). In men, osteoporosis was not associated with any type of AMD. In women, the status of osteoporosis in the femoral neck showed a linear relationship with AMD (P = 0.004). Although osteoporosis was associated with AMD in women, it showed no association with other age-related eye diseases; this suggested a disease-specific association.

Conclusions

Our findings suggest that osteoporosis plays a role in AMD development in postmenopausal women.

HLA class II genotypes are not associated with age related macular degeneration in a case-control, population-based study

Multiple lines of evidence support an immunologic basis and genetic disposition for the development of age-related macular degeneration (AMD). Comprehensive human leukocyte antigens (HLA) class II typing at four loci (DRB1, DQA1, DQB1, and DPB1) was assessed using next generation sequencing methods and tested for association with age-related macular degeneration (AMD) in a case-control study of 456 AMD cases and 499 controls from the population-based Study of Osteoporotic Fractures (SOF) cohort. No statistically significant associations were identified for any of the class II loci and a previously identified association between DRB1*13:01 was not replicated in this dataset. These results reported here suggest that common HLA class II genetic variation does not contribute to AMD disease risk.

Estrogen signalling in the pathogenesis of age-related macular degeneration

Age-related macular degeneration (AMD) is a multifactorial eye disease that is associated with aging, family history, smoking, obesity, cataract surgery, arteriosclerosis, hypertension, hypercholesterolemia and unhealthy diet. Gender has commonly been classified as a weak or inconsistent risk factor for AMD. This disease is characterized by degeneration of retinal pigment epithelial (RPE) cells, Bruch's membrane, and choriocapillaris, which secondarily lead to damage and death of photoreceptor cells and central visual loss. Pathogenesis of AMD involves constant oxidative stress, chronic inflammation, and increased accumulation of lipofuscin and drusen. Estrogen has both anti-oxidative and anti-inflammatory capacity and it regulates signaling pathways that are involved in the pathogenesis of AMD. In this review, we discuss potential cellular signaling targets of estrogen in retinal cells and AMD pathology.

Postmenopausal hormone therapy and age-related maculopathy in older women

PURPOSE

To examine the association between postmenopausal hormone therapy and Age-Related Maculopathy (ARM) in older women and to determine if these associations vary by smoking status.

METHODS

A cross-sectional analysis of 1065 women of European origin aged > or = 74 years attending the year-10 examination of the Study of Osteoporotic Fractures was performed. Fundus photographs were graded for ARM using a modification of the Wisconsin Age-Related Maculopathy Grading System used in NHANES III. Multiple imputation methods were used to examine the associations of type and duration of postmenopausal hormone therapy use with early and late ARM as well as interactions with smoking history.

RESULTS

Compared to never users, Neither estrogen alone (E), Estrogen plus progestin (E+P), nor duration of use was significantly associated with early ARM [odds ratio (OR) E = 1.01, 95% confidence interval (CI) 0.77-1.34; OR E+P = 0.85, 95% CI 0.55-1.35; OR < or = 3 years use = 1.04, 95% CI 0.74-1.47; OR > 3-12 years use = 0.93, 95% CI 0.64-1.35; OR > 12 years use = 0.95, 95% CI 0.65-1.37] or late ARM (OR any E/E+P = 0.59, 95% CI 0.29-1.19; OR < or = 3 years use = 0.73, 95% CI 0.30-1.77; OR > 3 years of use = 0.51, 95% CI 0.22-1.17), though power for late ARM was limited. Tests for smoking interactions were not significant.

CONCLUSIONS

This study found no evidence to support an association between use of E, E+P, or duration of use and ARM risk.

Prevalence of age-related macular degeneration in a Malay population: the Singapore Malay Eye Study

OBJECTIVE

To describe the prevalence of age-related macular degeneration (AMD) in an Asian Malay population.

DESIGN

Population-based cross-sectional study.

PARTICIPANTS

An age-stratified random sample of Malay persons aged 40 to 80 years living in Singapore.

METHODS

Participants were invited to a central clinic for a comprehensive examination.

MAIN OUTCOME MEASURES

Early and late AMD signs were graded from retinal photographs following the Wisconsin grading system.

RESULTS

Of 3280 participants who participated (78.7% response rate), 3265 had photographs of sufficient quality for grading of AMD signs. Early and late AMD were present in 160 (4.9%) and 23 (0.70%) participants, respectively. After age standardization, the prevalence of early AMD in Malay persons aged 40 to 80 years was estimated to be 3.5% (95% confidence interval [CI], 2.9%-4.1%) and that of late AMD was 0.34% (95% CI, 0.20%-0.49%). Early AMD was more prevalent in men than in women (6.1% vs. 3.8%); this was significant despite adjusting for age and smoking (odds ratio [OR], 1.56; 95% CI, 1.11-2.20). Late AMD also was more prevalent in men than in women (1.0% vs. 0.4%), although this was not statistically significant after adjusting for age and smoking (OR, 1.39; 95% CI, 0.52-3.68). The prevalence of early and late AMD was similar to that reported in the Blue Mountains Eye Study among white persons.

CONCLUSIONS

The prevalence of AMD in Asian Malay people is similar to that in white persons from the Blue Mountains Eye Study. Early AMD signs were more frequent in men compared with women, an association that was not fully explained by the higher smoking rates in men.