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.