Association Between The Severity Of Glaucoma And Risk Of Fractures: A Nationwide Cohort Study

Background: We evaluated the association between glaucoma and fracture risk in a retrospective cohort of individuals with (n = 3,810) and without (n = 3,810) glaucoma, matched 1:1 for age, sex, and index year obtained using Taiwan's National Health Insurance Research Database.Methods: Patients with glaucoma were categorized into three groups reflecting the glaucoma severity: no more than two types of medical treatment, more than two types of medical treatment, and surgery. Data were analyzed using Cox proportional hazard regression models.Results: During a mean follow-up period of 11.6 years, 750 participants with and 711 without glaucoma developed fractures. Glaucoma was significantly associated with increased fracture risk (adjusted HR [aHR] = 1.18, p = 0.005), particularly in the foot (aHR = 1.25, p < 0.001), femur (aHR = 1.24, p = 0.021), and hip (aHR = 1.30, p = 0.001), but not in the upper limbs and axial skeleton. Those who received more than two types of medical treatment showed a significant association with a higher fracture risk than did those who received no more than two types of medical treatment (aHR = 1.231, p = 0.026). However, patients with surgery showed a significant association with lower fracture risk than those who received medical treatment, with almost the same risk as that of patients without glaucoma.Conclusion: Glaucoma seems independently associated with increased fracture risk, especially lower-limb fractures. In patients receiving medical treatment for glaucoma, a higher degree of severity of glaucoma was significantly associated with higher fracture risk. The fracture risk was decreased in those with severe glaucoma warranting surgery. This is the first nationwide study concerning the epidemiological correlation between two diseases. Copyright (C) 2021, Taiwan Society of Geriatric Emergency & Critical Care Medicine.