The evaluation of tear production and dry eye symptoms in patients with osteoporosis

Aims: Osteoporosis is a systemic skeletal disorder characterized by decreased bone mass, compromised bone density and strength. Dry eye is a common disease of the ocular surface characterized by tear film instability with ocular discomfort, pain, and visual disturbances. Both conditions share risk factors, including age, gender, and hormonal factors. In this study, our aim is to assess the tear production and dry eye symptoms in patients with osteoporosis and compare their results a control group without osteoporosis. Methods: In this cross-sectional study, we evaluated 32 osteoporosis patients and 30 age-matched controls without osteoporosis. Tear production was assessed using Schirmer test and the symptoms of dry eye using Ocular Surface Disease Index (OSDI) questionnaire. The results of both groups were compared. Results: The mean age of the osteoporosis group was 61.4±4.9 years, and the mean age of the control group was 57.7±6.4 years (p:0.224). The Schirmer test results were 12.3±7.4 mm for the osteoporosis group and 23.1±13.7 mm for the control group. The Schirmer test results were significantly lower in the osteoporosis group (p:0.009). The mean OSDI scores for the osteoporosis group was 30.4±23.1 while it was 20.6±14.6 for the control group. The difference was not statistically significant (p:0.329). Conclusion: This study reveals a potential connection between osteoporosis and dry eye. Patients with osteoporosis have lower tear production compared to control group without osteoporosis. Further research is necessary to understand this relationship and its implications.

Keywords:

Osteoporosis, Dry Eye Schirmer test, ocular surface disease index,

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Jeng YT, Lin SY, Hu HY, Lee OK, Kuo LL. Osteoporosis and dry eye syndrome: A previously unappreciated association that may alert active prevention of fall. PLoS One. 2018;13(11):e0207008.
Rachner TD, Khosla S, Hofbauer LC. Osteoporosis: now and the future. Lancet (London, England). 2011;377(9773):1276-87.
Sheik Ali A. Osteoporosis: A Narrative Review. Cureus. Aug 2023;15(8):e43031.
Sözen T, Özışık L, Başaran N. An overview and management of osteoporosis. Eur J Rheumatol. Mar 2017;4(1):46-56.
Court-Brown CM, Caesar B. Epidemiology of adult fractures: A review. Injury. 2006;37(8):691-697.
Stapleton F, Alves M, Bunya VY, et al. TFOS DEWS II Epidemiology Report. The Ocul Surface. Jul 2017;15(3):334-365.
Borrelli M, Frings A, Geerling G, Finis D. Gender-specific differences in signs and symptoms of dry eye disease. Curr Eye Res. 2021;46(3):294-301.
Qian L, Wei W. Identified risk factors for dry eye syndrome: A systematic review and meta-analysis. PLoS One. 2022;17(8):e0271267.
Gorimanipalli B, Khamar P, Sethu S, Shetty R. Hormones and dry eye disease. Indian J Ophthalmol. 2023;71(4):1276-1284.
Albrecht K, Dörner T, Redeker I, et al. Comorbidity and health care utilisation in persons with Sjögren's syndrome: a claims data analysis. Clin Exp Rheumatol. Jul-Aug 2020;38 Suppl 126(4):78-84.
Yip JL, Khawaja AP, Broadway D, et al. Visual acuity, self-reported vision and falls in the EPIC-Norfolk Eye study. Br J Ophthalmol. Mar 2014;98(3):377-82.
Wolffsohn JS, Arita R, Chalmers R, et al. TFOS DEWS II Diagnostic Methodology report. The Ocul Surface. Jul 2017;15(3):539-574.
Barabino S, Labetoulle M, Rolando M, Messmer EM. Understanding Symptoms and Quality of Life in Patients With Dry Eye Syndrome. The Ocular Surface. 2016/07/01/ 2016;14(3):365-376.
Irkec MT, Group TOS. Reliability and Validity of Turkish Translation of the Ocular Surface Disease Index (OSDI) in Dry Eye Syndrome. Invest Ophthalmol Vis Sci. 2007;48(13):408-408.
Hat K, Planinić A, Ježek D, Kaštelan S. Expression of Androgen and Estrogen Receptors in the Human Lacrimal Gland. International journal of molecular sciences. Mar 15 2023;24(6):5609
Feng Y, Feng G, Peng S, Li H. The Effect of Hormone Replacement Therapy on Dry Eye Syndrome Evaluated with Schirmer Test and Break-Up Time. Journal of ophthalmology. 2015;2015:420302.
Peck T, Olsakovsky L, Aggarwal S. Dry eye syndrome in menopause and perimenopausal age group. J Midlife Health. 2017;8(2):51-54.
Voulgaridou G, Papadopoulou SK, Detopoulou P, et al. Vitamin D and Calcium in Osteoporosis, and the Role of Bone Turnover Markers: A Narrative Review of Recent Data from RCTs. Diseases (Basel, Switzerland). Feb 8 2023;11(1):29
Liu J, Dong Y, Wang Y. Vitamin D deficiency is associated with dry eye syndrome: a systematic review and meta-analysis. Acta Ophthalmol. Dec 2020;98(8):749-754.
Jin KW, Ro JW, Shin YJ, Hyon JY, Wee WR, Park SG. Correlation of vitamin D levels with tear film stability and secretion in patients with dry eye syndrome. Acta Ophthalmol. 2017;95(3):e230-e235.