Does osteoporosis affect your eyes? Unpacking the surprising connections

September 30, 2025 •

5 min read

According to one large-scale study, patients with osteoporosis have a significantly increased risk of developing dry eye syndrome. While not a direct cause-and-effect relationship, this unexpected finding shows that the question, "Does osteoporosis affect your eyes?" is more complex than it appears, with research highlighting several systemic links between these seemingly unrelated conditions.

Quick Summary

Osteoporosis is linked to several eye conditions, including dry eye, cataracts, and macular degeneration, through shared risk factors like inflammation, hormones, and vitamin D deficiency. Certain osteoporosis medications can also cause rare eye inflammation. A very rare genetic disorder, Osteoporosis-Pseudoglioma Syndrome, directly causes both severe bone thinning and vision loss.

Key Points

Osteoporosis is linked to Dry Eye Syndrome: Large studies show a significant association, likely due to shared risk factors like hormonal changes, inflammation, and vitamin D deficiency.
Cataracts are more prevalent in osteoporosis patients: Research indicates a higher prevalence of cataracts among those with osteoporosis, potentially due to calcium imbalances and shared genetic predispositions.
Low bone density may increase AMD risk in women: Some evidence suggests an association between low bone mineral density and an elevated risk of age-related macular degeneration, particularly in women.
Certain osteoporosis medications can cause eye inflammation: Bisphosphonates, a common treatment, may rarely cause side effects like uveitis, episcleritis, and conjunctivitis.
Visual impairment increases fall risk in osteoporosis patients: The visual disturbances caused by related eye conditions can increase the risk of falls and subsequent fractures in individuals with weakened bones.
A rare genetic syndrome links both directly: Osteoporosis-Pseudoglioma Syndrome (OPPG) is a very rare genetic disorder that causes both severe juvenile-onset osteoporosis and blindness from infancy.
Addressing systemic health benefits both eyes and bones: Because many links are systemic, maintaining overall health through diet, exercise, and addressing inflammation is beneficial for both conditions.

For many, the idea that a skeletal disease could impact eyesight is a foreign concept. After all, what do weak bones have to do with the health of your eyes? However, recent scientific studies have identified several intriguing connections between osteoporosis and various ocular conditions. This article will explore the ways in which a diagnosis of osteoporosis may relate to your eye health, from common inflammatory pathways to the potential side effects of treatment.

The Systemic Connections Between Bone and Eye Health

The link between osteoporosis and certain eye conditions is not accidental but is instead driven by shared systemic factors and biological processes. These commonalities often explain why the two conditions may appear together, particularly in older individuals and women.

Dry Eye Syndrome (DES)

One of the most robust associations found in research is between osteoporosis and dry eye syndrome (DES). DES is a multifactorial disease that results in tear film instability, causing visual disturbances and discomfort. The shared risk factors that link the two conditions include:

Hormonal Changes: Decreased estrogen and androgen levels in postmenopausal women are a primary risk factor for osteoporosis. The same hormonal shifts also impact the function of the meibomian glands in the eyelids, which are essential for producing the oily layer of the tear film. Androgen deficiency, for example, is associated with DES.
Inflammation: Chronic, low-grade systemic inflammation and oxidative stress are implicated in the progression of both osteoporosis and dry eye syndrome. Certain cytokines that promote bone resorption are also present in ocular inflammatory conditions.
Vitamin D Deficiency: Many older adults with osteoporosis also have a vitamin D deficiency. Vitamin D plays a crucial role in regulating both bone metabolism and the body's inflammatory response, which is relevant to both bone density and tear film stability.

Cataracts

Another significant association has been found between osteoporosis and the development of cataracts. In cataracts, the lens of the eye becomes cloudy, leading to blurred or cloudy vision. Researchers have identified several potential links, including:

Calcium Imbalance: While osteoporosis is a condition of low bone density, it is also rooted in a complex imbalance of calcium metabolism. Similarly, maintaining proper calcium balance within the eye's lens is critical for its clarity. Abnormal calcium concentrations are found in cataractous human lenses.
Steroid Use: Long-term use of corticosteroids is a risk factor for both secondary osteoporosis and posterior subcapsular cataracts. This connection points to a shared pathological pathway initiated by these medications.
Shared Genetics: Certain genes involved in bone formation have also been identified as potentially playing a role in cataract development.

Age-Related Macular Degeneration (AMD)

Some studies suggest a link between low bone mineral density (BMD) and an increased risk of age-related macular degeneration (AMD), especially in women. AMD is a progressive retinal disorder that can cause central vision loss. Evidence for this association includes:

Shared Pathology: Microscopic spherical deposits containing bone mineral, known as hydroxyapatite, have been found in the eyes of patients with AMD. This finding suggests a potential shared pathology between bone and eye tissue degeneration.
Calcium Homeostasis: While some older studies linked calcium supplementation to an increased risk of AMD, more recent data from large studies have contradicted this, finding that higher calcium intake is actually inversely associated with AMD progression in women. The complex role of calcium metabolism warrants further research.
Systemic Factors: Systemic inflammation and metabolic syndrome, both potential contributors to osteoporosis, are also being explored as possible links to AMD.

Medication-Induced Eye Issues

Beyond the systemic connections between the two diseases, some eye problems can arise as a rare side effect of bisphosphonate medications used to treat osteoporosis. These drugs, such as alendronate (Fosamax) and zoledronic acid (Reclast), can cause ocular inflammation.

Symptoms of bisphosphonate-related eye inflammation can include:

Conjunctivitis (pink eye)
Episcleritis (inflammation of the white part of the eye)
Anterior uveitis (inflammation inside the eye)
Scleritis (severe inflammation of the sclera)
Orbital inflammation

These side effects are uncommon, and the risk of severe vision problems is low. Intravenous forms of bisphosphonates are thought to have a higher rate and quicker onset of ocular inflammation. However, patients should notify their doctor immediately if they experience any eye pain, redness, or blurred vision while on these medications.

The Genetic Factor: Osteoporosis-Pseudoglioma Syndrome

In extremely rare cases, a direct genetic link causes both severe osteoporosis and significant eye abnormalities. This condition is called Osteoporosis-Pseudoglioma Syndrome (OPPG), an autosomal recessive disorder caused by a mutation in the LRP5 gene. The LRP5 protein is essential for both bone mineral density regulation and retinal development.

Key features of OPPG include:

Severe, juvenile-onset osteoporosis and frequent fractures.
Congenital or infantile blindness, often due to retinal issues.

This genetic syndrome is distinct from standard age-related osteoporosis, but it powerfully illustrates that bone development and eye health can be controlled by the same underlying genetic pathways.

The Connection Between Visual Impairment and Fracture Risk

While osteoporosis may affect the eyes, the reverse is also true. Visual impairment from any cause, including dry eye or cataracts, is a known risk factor for falls and fractures in the elderly, who are also more likely to have osteoporosis. A study confirmed that patients with osteoporosis who also had age-related macular degeneration (AMD) had a higher risk of spinal and hip fractures compared to those with osteoporosis alone. This creates a dangerous feedback loop where weak bones and poor eyesight amplify the risk of severe injury. Improving vision through cataract surgery, for example, has been associated with a lower risk of falls and fractures.

Comparison of Osteoporosis-Associated Ocular Conditions


Feature	Dry Eye Syndrome (DES)	Cataracts	Age-Related Macular Degeneration (AMD)
Associated with Osteoporosis	Yes, strong epidemiological link.	Yes, significant epidemiological link.	Yes, associated with low bone density, especially in women.
Shared Risk Factors	Hormonal changes, inflammation, vitamin D levels.	Calcium imbalance, steroid use, some genetic factors.	Systemic inflammation, mineral deposits (hydroxyapatite), some metabolic links.
Type of Condition	Chronic ocular surface disease affecting tear film stability.	Clouding of the eye's lens.	Progressive retinal disorder affecting central vision.
Mechanism of Link	Affects tear production and tear quality.	May involve mineral balance and shared genetic factors.	Low bone density is a risk factor, possibly linked to inflammation.
Vision Impact	Discomfort, visual disturbance, and blurred vision.	Cloudy, blurred, or double vision.	Central vision loss.

Conclusion

The idea that does osteoporosis affect your eyes? is not just a theoretical question, but one supported by a growing body of evidence. While osteoporosis does not directly cause vision loss for most patients, shared underlying factors such as hormonal changes, systemic inflammation, vitamin D status, and genetic predisposition create significant associations with several common eye conditions, including dry eye syndrome, cataracts, and AMD. Furthermore, treatment with bisphosphonates can, in rare instances, lead to inflammatory eye complications. Given these connections, healthcare providers treating patients with osteoporosis should be aware of potential eye health issues. For patients, maintaining both bone and eye health requires a holistic approach that includes addressing underlying health factors and having regular eye exams, especially as visual impairment can also increase the risk of debilitating falls. Early detection and treatment of both conditions are crucial for preserving long-term quality of life.

For more detailed information on research into osteoporosis and dry eye syndrome, see the study by Jeng et al. on the PLOS ONE journal platform.(https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0207008)

Frequently Asked Questions

Yes, although it is rare, bisphosphonate medications used for osteoporosis have been associated with ocular inflammation. Reported side effects include uveitis, episcleritis, conjunctivitis, and scleritis. Patients should report any eye pain or redness to their doctor.

The link is complex and multifaceted, involving shared risk factors rather than a direct mechanism. Common factors include age, hormonal imbalance, systemic inflammation, and vitamin D deficiency, all of which affect both bone metabolism and the tear film that lubricates the eyes.

Yes, studies have found an association between osteoporosis and a higher prevalence of cataracts. Possible shared factors include calcium metabolism imbalance and some genetic predispositions.

Yes, decreased vision from conditions like cataracts or macular degeneration is an important risk factor for falls. For individuals with weakened bones from osteoporosis, this significantly increases the likelihood of a fracture.

Improving eye health can indirectly benefit those with osteoporosis by reducing the risk of falls and fractures. For example, some research suggests that having cataract surgery can lower the risk of fractures in older adults.

No, OPPG is a distinct, extremely rare genetic disorder caused by a specific gene mutation (LRP5) that results in severe juvenile osteoporosis and blindness from infancy. It is not the same as the common, age-related osteoporosis.

While the links are not a guaranteed outcome, it is prudent to be aware of the associations and the shared risk factors. Regular eye exams and communication with your healthcare provider about any changes in your vision or eye comfort are recommended, especially if taking bisphosphonates.