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.