Skeletal status in subjects with poor visual acuity in independent and institutionalized subjects
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Department and Chair of Pathomorphology in Zabrze, Medical University of Silesia in Katowice
Metabolic Bone Diseases Unit, Department and Clinic of Internal Diseases, Diabetology and Nephrology, Medical University of Silesia in Katowice
Department of Ophtalomology, Sosnowiec
Department of Nephrology, Hospital in Raciborz
KCR S.A., Warszawa
Department and Clinic of Pediatrics, Medical University of Silesia in Katowice
Bogna Drozdzowska   

Dept. of Pathomorphology 3 Maja 13/15 Street, 41-800 Zabrze, Poland tel./ fax +48322714994
Ann. Acad. Med. Siles. 2010;64:16–21
The aim of the study was to evaluate skeletal status in subjects with poor vision.

Material and Methods:
Skeletal status was assessed in a group of subjects with poor visual acuity living independently in general community or institutionalized in a nursing home. A group of 91 subjects (47 females - 29 living independently and 18 from nursing home and 44 males - 19 and 25, respectively) were studied. Mean age was 61.3+/-16.8 y. in females and 61.4+/-10.9 y. in males. Binocular visual acuity was evaluated using a Snellen acuity chart. Skeletal status was assessed by dual-energy X-ray absorptiometry at the calcaneus and forearm using PIXI (Lunar, USA) which measures bone mineral density (BMD) and by quantitative ultrasound at hand phalanges using DBM Sonic 1200 (IGEA, Italy) measuring Amplitude-dependent Speed of Sound (Ad-SoS [m/s]).

Binocular visual acuity was 0.179+/-0.2 in females and 0.09+/-0.14 in males and was significantly lower in males (p<0.01). A visual acuity did not correlate with skeletal variables in either of sexes and was significantly lower in males from nursing home in comparison to males living independently (p<0.001) what was not observed in females. Z-scores were used in order to obtain age-adjusted comparisons of skeletal variables between subjects living independently and in nursing home. In females Z-scores for forearm (-0.304+/-0.92 vs –1.044+/-0.74, p<0.01) and calcaneus (-0.017+/-0.97 vs –1.38+/-0.63, p<0.00001) were significantly higher in individuals living independently than in nursing home, and Z-score for Ad-SoS did not differ significantly. In males no significant differences in Z-scores were noted.

The results of the study suggest that in both genders fracture risk in institutionalized subjects may be increased; in females due to affected skeletal status, and in males as a consequence of poor vision.

Ivers R.Q., Optom B., Cumming R.G., Mitchell P, Attebo K. Visual impairment and falls in older adults: The Blue Mountains Eye Study. J Am Geriatr Soc 1998;46:58-64.
Klein B.E.K., Klein R, Lee K.E. Cruickshanks KJ. Performance-based and self-assessed measures of visual function as related to history of falls, hip fractures, and measured gait time. Ophthamology 1998:105:160-164.
Tinetti M.E., Williams T.F., Mayewski R. Fall risk index for elderly patients based on number of chronic disabilities. Am J Med 1986:80:429-434.
Felson D.T., Anderson J.J., Hannan M.T., Milton R.C., Wilson P.W.F., Douglas P.K., Impaired vision and hip fracture. The Framingham Study. J Am Geriatr Soc 1989:37:495-500.
Cummings S.R., Nevitt M.C., Browner WS. et al. Risk factors for hip fracture in white women. NEJM 1995;332:767-773.
Dargent-Molina P., Favier F., Grandjean H. et al. Fall-related factors and risk of hip fracture: the EPIDOS prospective study. Lancet 1996:348:145-149.
Ivers R.Q., Norton R., Cummings R.G., Butler M., Campbell A.J., Visual impairment and risk of hip fracture. Am J Epidemiol 2000;152:633-639.
Lamourex E., Gadqil S., Pesudovs K., et al. The relationship between visual function, duration and main causes of vision loss and falls in older people with low vision. Graefes Arch Clin Exp Ophthtalmol 2010;248:527-33.
Miazgowski T., Krzyzanowska-Swinarska B., Ogonowski J., Noworyta-Zietara M. Czy cukrzyca typu 2 predysponuje do osteoporotycznych złamań kości? Endokrynol Pol. 2008;59:224-9.
National Osteoporosis Foundation. Osteoporosis: review of the evidence for prevention, diagnosis, and treatment and cost-eff ectiveness analysis. Osteoporos Int 1998;8(suppl.4):S1-S88.
Pluijm S.M.F., Graafmans W.C., Bouter L.M., Lips P. Ultrasound measurements for the prediction of osteoporotic fractures in elderly people. Osteoporos Int 1999;9:550- 556.
Drozdzowska B., Pluskiewicz W. The ability of quantitative ultrasound at the calcaneus to identify postmenopausal women with diff erent types of nontraumatic fractures. Ultrasound Med Biol 2002;28:1491-1497.
Pluskiewicz W., Drozdzowska B. Ultrasound measurements of proximal phalanges in Polish early postmenopausal women. Osteoporos Int 1998;8:578-583.
Wűster C, Albanese C, de Aloysio D et al. Phalangeal osteosonogrammetry study: age-related changes, diagnostic sensitivity, and discrimination power. J Bone Miner Res 2000;15:1603-1614.
Mele R., Masci G., Ventura V., de Aloysio D., Bicocchi M., Cadossi R., Three-year longitudinal study with quantitative ultrasound at the hand phalanx in a female population. Osteoporos Int 1997;7:550- 557.
March LM, Cameron ID, Cumming RG. et al. Mortality and morbidity after hip fracture: can evidence based clinical pathways make a diff erence. J Rheumatol 2000;27:2227-31.
Sainz-Gomez C, Fernandez-Robredo P, Salinas-Alaman A. et al. Prevalence and causes of bilateral and visual impairment among institutionalized elderly people in Pamplona, Spain. Eur J Ophthalmol 2010;20:442-50.
Damian J., Pastor-Barriuso R., Valderrama- Gama E. Factors associated with selfrated health in older people living in institutions. BMC Geriatr 2008;27:8-5.
Zochling J., Sitoh Y.Y., Lau T.C. et al. Quantitative ultrasound of the calcaneus and falls risk in the institutionalized elderly: sex diff erences and relationship to vitamin D status. Osteoporos Int 2002;13:882- 887.
Krieg M.A., Thiebaud D., Burckhardt P. Quantitative ultrasound of bone in institutionalized elderly women: a cross-sectional and longitudinal study. Osteoporos Int 1996;6:189-195.
Schott A.M., Weill-Engerer S., Hans D., Duboef F., Delmas P.D., Meunier P.J. Ultrasound discriminates patients with hip fracture equally well as dual-energy X-ray absorptiometry and independently of bone mineral density. J Bone Miner Res 1995:10:243-9.
Espallargues M., Sampietro-Colom L., Estrada M.D., Sola M., del Rio L., Setoain J. Identifying bone-mass-related risk factors for fracture to guide bone densitometry measurements: a systemic review of the literature. Osteoporos Int 2001;12:811-822.
Berdeaux G, Brezin A.P., Fagnani F., Lafuma A., Mesbah M. Self-reported visual impairment and mortality: a French nationwide perspective. Ophthalmic Epidemiol 2007;14:80-7.
Haran M.J., Cameron I.D., Ivers R.Q., et al. Eff ect on falls of providing single lens distance vision glasses to multifocal glasses wearers: VISIBLE randomised controlled trial. BMJ 2010;340:c2265.doi:10.1136/ bmj.c2265.
Timmis M.A., Johnson L., Elliott D.B., Buckley J.G. Use of single-vision distance spectacles improves landing control during step descent in well-adapted multifocal lens-wearers. Invest Ophthalmol Vis Sci 2010;51(8):3903-8.