PLOS ONE · 13 authors, 6 centres
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This population-based study of 436 Polish adults aged 50–80 found that decreased femoral bone mineral density was significantly associated with age-related macular degeneration in men, but not in women. Men with AMD had a 4.65-fold higher odds of low femoral T-scores compared to those without AMD. The findings suggest that screening for AMD should be considered in men with osteopenia, though a causal link remains unclear.
**Background:** Age-related macular degeneration (AMD) is the leading cause of irreversible blindness in developed countries, while osteoporosis affects approximately 19.7% of the global population. Both conditions are common in individuals over 50 and may coexist, worsening health outcomes and quality of life. This study aimed to analyze the relationship between AMD and decreased bone mineral density (BMD) in the Polish population.
**Methods:** Participants were derived from the population-based Bialystok PLUS Study, a prospective cohort with a fully randomized design. A total of 436 Caucasian participants aged 50–80 years (252 women, 184 men) were included. AMD was diagnosed using fundus photography graded according to the Wisconsin AMD grading system and the modified International Classification System by retinal specialists. Participants were stratified into AMD-1 (with AMD) and AMD-0 (without AMD) groups. BMD was measured using dual-energy X-ray absorptiometry (Lunar iDXA). A T-score cutoff of -1.0 was used to define low bone mass (osteopenia/osteoporosis). Statistical analyses included Mann–Whitney U-test, Student t-test, chi-square test, and logistic regression models.
**Key Results:** AMD was diagnosed in 47 participants (10.8%): 9.9% of women and 12.0% of men. Decreased BMD (T-score < -1.0) was observed in 36.9% of women and 18.9% of men. Significant differences in femoral BMD between AMD-0 and AMD-1 groups were found only in men: mean difference in femoral BMD = 0.11 g/cm² (95% CI: 0.02–0.13; p = 0.012) and mean difference in femur T-score = 0.73 (95% CI: 0.015–0.94; p = 0.011). Among men, 46% in the AMD-1 group had low femoral T-scores vs. 15% in the AMD-0 group (OR = 4.65; 95% CI: 1.81–11.97; p = 0.001). In univariate logistic regression, a one-unit increase in femoral BMD was associated with a 98% decrease in AMD risk in men (OR = 0.02; 95% CI: <0.01–0.80; p = 0.043), and a one-unit increase in femur T-score was associated with a 42% risk reduction (OR = 0.58; 95% CI: 0.34–0.96; p = 0.041). For women, only age was a significant predictor of AMD (OR = 1.08 per year; 95% CI: 1.02–1.15; p = 0.012). Multivariable models adjusting for age confirmed femoral BMD and T-score as significant predictors in men but not in women. No associations were observed between serum 25-hydroxyvitamin D levels and AMD or low BMD.
**Clinical Implications:** This study provides evidence of an association between decreased femoral BMD and AMD in men over 50, suggesting that men with osteopenia may be at higher risk for AMD. The authors recommend considering routine AMD screening (e.g., Amsler grid test) in male patients with low bone density. The lack of association in women may be due to age differences between groups or hormonal factors. The study highlights the need for further longitudinal research with larger samples to confirm these findings and explore shared pathogenic mechanisms, such as impaired autophagy and p62/SQSTM1 protein dysfunction, which may underlie both conditions.