The Association between Glaucoma Severity and Hip Fractures in California Medicare Beneficiaries

Sayan K Chatterjee; Ramin Talebi; Ken Kitayama; Andrew G Young; Fei Yu; Victoria L Tseng; Anne L Coleman

doi:10.1016/j.ogla.2024.10.002

The Association between Glaucoma Severity and Hip Fractures in California Medicare Beneficiaries

Ophthalmol Glaucoma. 2024 Oct 16:S2589-4196(24)00180-7. doi: 10.1016/j.ogla.2024.10.002. Online ahead of print.

Authors

Sayan K Chatterjee¹, Ramin Talebi², Ken Kitayama³, Andrew G Young³, Fei Yu⁴, Victoria L Tseng³, Anne L Coleman⁵

Affiliations

¹ David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California.
² Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania; Department of Ophthalmology, Stein and Doheny Eye Institutes, University of California, Los Angeles, Los Angeles, California.
³ Department of Ophthalmology, Stein and Doheny Eye Institutes, University of California, Los Angeles, Los Angeles, California.
⁴ Department of Ophthalmology, Stein and Doheny Eye Institutes, University of California, Los Angeles, Los Angeles, California; Department of Biostatistics, Fielding School of Public Health, University of California, Los Angeles, Los Angeles, California.
⁵ Department of Ophthalmology, Stein and Doheny Eye Institutes, University of California, Los Angeles, Los Angeles, California; Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, Los Angeles, California. Electronic address: coleman@jsei.ucla.edu.

PMID: 39419201
DOI: 10.1016/j.ogla.2024.10.002

Abstract

Purpose: To examine the association between glaucoma severity and hip fractures in older adults.

Design: Retrospective cross-sectional study.

Subjects: California (CA) Medicare beneficiaries in 2019 with Parts A & B coverage.

Methods: Multivariable logistic regression was used to analyze the association between glaucoma severity (mild, moderate, and severe vs. no glaucoma) and hip fracture, after adjusting for age, sex, race and ethnicity, and Charlson Comorbidity Index score. A subgroup analysis was performed only in individuals with glaucoma to examine the odds of hip fracture for those with moderate and severe glaucoma compared to those with mild glaucoma.

Main outcome measures: The variations in the odds of hip fractures for patients with and without glaucoma and for patients with moderate and severe glaucoma compared to those with mild glaucoma.

Results: Of the 2 717 346 beneficiaries in the study population, 220 662 (8.1%) had glaucoma. In multivariable regression analysis, those with mild (odds ratio [OR]: 0.83; 95% confidence interval [CI]: 0.78-0.88) and moderate glaucoma (OR: 0.88; 95% CI: 0.84-0.92) had reduced odds of hip fracture compared with those with no glaucoma. There was no statistically significant association between severe vs. no glaucoma and hip fracture (OR: 0.96; 95% CI: 0.91-1.02). Among individuals with glaucoma, the odds of hip fracture were higher for those with severe glaucoma (OR: 1.17; 95% CI: 1.08-1.27), compared with those with mild glaucoma.

Conclusions: In the CA Medicare population, the presence of glaucoma was associated with decreased likelihood of hip fracture. However, in those with glaucoma, increased glaucoma severity was associated with an increased likelihood of hip fracture. Potential mediating mechanisms requiring further study include fear of falls and physical inactivity in patients with glaucoma.

Financial disclosure(s): Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

Keywords: Falls; Glaucoma; Hip fractures; Medicare; Vision loss.