Reduced Risk of Fracture in Patients Who Undergo Cataract Surgery

Results of a retrospective study [JAMA. 2012;308(5):493-501] show that older people  with a diagnosis of cataract who undergo cataract surgery have lower odds of fracturing their hip within 1 year compared with people with cataracts who do not undergo cataract surgery.

Although poor vision and cataracts are associated with an increased risk of falling and fracture, few data are available on the relationship between cataract surgery and the incidence of falling.

Using data from the Centers for Medicare & Medicaid Services (CMS), the study examined and compared the 1-year fracture incidence in a random sample of Medicare Part B beneficiaries who did or did not undergo cataract surgery between 2002 through 2009. Patients were excluded from the study if they were <65 years of age, resided outside the United States, were not covered by Medicare Part B, were covered by a health maintenance organization not processed through CMS, or had a history of cataract surgery before the study period.

A total of 1,113,640 patients were included in the study–410,809 of those patients received cataract surgery and 702,831 received a diagnosis of cataracts, but did not undergo surgery. Of the entire cohort, most patients were female (59.9%) and white (88.1%). Patients who underwent cataract surgery were older than patients in the cataract diagnosis group.

The study found that the overall 1-year fracture incidence during the study period was 1.3% (n=13,976) for hip fracture and 5.4% (59,791) for any fracture. Osteoporosis was the most common comorbidity related to fracture occurring in 134,335 patients (12.1%), and glaucoma was the most common ocular comorbidity occurring in 212,382 patients (19.1%).

When adjusting for all demographic and comorbidity factors (age, sex, race/ethnicity, US region of residence, Charlson Comorbidity Index [CCI] score, osteoporosis, hyperthyroidism, hyperparathyroidism, glaucoma, age-related macular degeneration, diabetes with ophthalmic manifestations, severe cataract, and having ≥1 physically limiting condition) using a propensity score that was utilized to divide patients into subgroups, the study found that patient subgroups had lower odds of hip fracture following cataract surgery compared with those who did not receive cataract surgery; the subgroups included patients with severe cataract, patients most likely to receive cataract surgery based on propensity score, patients ≥75 years of age, and patients with a CCI score of ≥3.

For example, the study found that patients who underwent cataract surgery with a CCI score of 3 or 4 were 28% less likely to experience a fracture than patients in the cataract diagnosis group who were equally sick (OR, 0.72; 95% confidence interval [CI], 0.68-0.77).  In addition, patients ≥75 years of age who underwent cataract surgery had a lower odds ratio of fracture than patients of the same age in the cataract diagnostic group, with the lowest odds of hip fracture for patients 80 to 84 years of age (OR, 0.72; 95% CI, 0.67-0.78).

Limitations of the study included its observational and retrospective study design and use of administrative data that lacked, for example, certain codes for parameters relevant to the study.

Strengths included the large sample size and the inclusion of regional and demographic data that permitted assessment and control for a wide range of conditions in a diverse patient population.

Summarizing their findings, the authors said, “In a cohort of US Medicare beneficiaries ≥65 years of age with a diagnosis of cataract, patients who had cataract surgery had lower odds of hip fracture within 1 year compared with patients who had not undergone cataract surgery.” These findings “suggest the need for further investigation of the additional potential benefit of cataract surgery as a cost-effective intervention to decrease the incidence of fractures in the elderly,” they concluded.