Study finds reduced risk of fracture after cataract surgery

Patients who received cataract surgery had a lower rate of fractures compared with patients who did not undergo surgery, according to a poster presented at the AAOS 2025 Annual Meeting. The findings underscore the importance of treating cataracts to reduce the risk of injury in older patients. The study was presented by Mohammed Abdullah, MD, orthopaedic surgery resident at the University of Pennsylvania Perelman School of Medicine.

As Dr. Abdullah told AAOS Now, “This study was motivated by the growing recognition of cataract-related visual impairment as a modifiable risk factor for falls and fractures in the elderly. With fractures representing a significant source of morbidity and mortality in this population, we aimed to evaluate whether cataract surgery, a highly effective treatment for restoring vision, could serve as a preventive measure against orthopaedic trauma.”

The researchers utilized the TriNetX database to identify patients who underwent cataract surgery as well as a control group of patients with age-related cataracts who did not receive surgical treatment. The researchers excluded patients with other potentially significant ophthalmic conditions (e.g., glaucoma) or preexisting orthopaedic conditions that increased fracture risk (e.g., primary bone tumor or metastases). Before propensity score matching, the study included 236,652 patients who underwent cataract surgery and 818,425 who did not. The cataract surgery group was slightly older, with a slight predominance of male patients. There was also variation in racial demographics, with white patients comprising 71.33% of the cataract surgery group compared with 52.99% of the control group. Hispanic or Latino patients comprised 8.95% and 4.48% of the surgery and control groups, respectively. Patients who received cataract surgery were more likely to have age-related osteoporosis without pathological fracture than patients in the control group (4.75% vs. 3.71%).

Cohorts were matched 1:1 based on demographics and relevant risk factors. The final analysis included 233,335 patients each in the cataract surgery and control groups. One-year and lifetime risk of fractures of the hip, vertebral body, distal radius, bimalleolar/trimalleolar ankle, and proximal humerus were collected, excluding risk from the first 90 days postoperatively.

Overall, cataract surgery was associated with a significant decrease in the number of fractures in most locations, with the largest effect size observed for trimalleolar ankle fracture (risk ratio [RR], 0.83; 95% confidence interval [CI], 0.71-0.96). Other areas with notable reductions in fracture risk were distal radius (RR, 0.87; 95% CI, 0.81-0.93) and proximal humerus (RR, 0.92; 95% CI, 0.85-0.99). The risk of hip fractures showed a smaller reduction after cataract surgery (RR, 0.90; 95% CI, 0.85-0.96), along with vertebral fractures (RR, 0.93; 95% CI, 0.88-0.97). There was no significant difference in risk of bimalleolar ankle fractures with or without cataract surgery (RR, 0.88; 95% CI, 0.77-1.01).

“The most unexpected finding was the pronounced reduction in trimalleolar ankle fractures, which decreased by 17%,” Dr. Abdullah shared. “While reductions in distal radius and proximal humerus fractures were observed, bimalleolar ankle fractures did not show a statistically significant reduction, underscoring the complexity of fracture patterns in geriatric populations.”

The study had several limitations, including the retrospective design, which “introduces potential residual confounding and selection bias,” Dr. Abdullah said. The study also lacked granular data regarding cataract severity and visual acuity, which diminished the researchers’ ability to fully elucidate the relationship between fracture risk and vision impairment, he noted. “The reliance on electronic medical record data from predominantly high-income countries may reduce the generalizability of the findings,” he added.

Based on these findings, Dr. Abullah said, “Future research should explore the mechanisms underlying the observed protective effects of cataract surgery on fracture risk. Additionally, studies could investigate how integrating vision screening and treatment into fracture-prevention programs might improve outcomes.” He also called for further investigations into the role of cataract grade and visual acuity pre- and postoperatively to help modulate fracture risk.

Dr. Abdullah recommended, “Cataract surgery should be considered an integral part of geriatric care, not only for improving visual acuity but also for its protective effects against fractures. Routine vision assessments and timely surgical intervention for cataracts could significantly enhance patient safety and reduce the burden of orthopaedic trauma.”

Dr. Abdullah’s co-author of “‘I can see the light’: Cataract surgery decreases risk of orthopaedic trauma” is Samir Mehta, MD, FAAOS.

Rebecca Araujo is the managing editor of AAOS Now. She can be reached at raraujo@aaos.org.