Gout increases risk of fracture

Abstract

There is still debate on whether high uric acid increases bone mineral density (BMD) against osteoporotic fracture or bone resorption caused by gout inflammation. This study aimed to evaluate whether gout offers a protective effect on bone health or not. We conducted a nationwide population-based retrospective cohort study to evaluate the association between gout history and risk factors of fracture.A retrospective cohort study was designed using the claim data from Longitudinal Health Insurance Database (LHID). A total of 43,647 subjects with gout and a cohort of 87,294 comparison subjects without gout were matched in terms of age and sex between 2001 and 2009, and the data were followed until December 31, 2011. The primary outcome of the study was the fracture incidence, and the impacts of gout on fracture risks were analyzed using the Cox proportional hazards model.After an 11-year follow-up period, 6992 and 11,412 incidents of fracture were reported in gout and comparison cohorts, respectively. The overall incidence rate of fracture in individuals with gout was nearly 23%, which was higher than that in individuals without gout (252 vs 205 per 10,000 person-years) at an adjusted hazard ratio of 1.17 (95% confidence interval = 1.14–1.21). Age, sex, and fracture-associated comorbidities were adjusted accordingly. As for fracture locations, patients with gout were found at significant higher fracture risks for upper/lower limbs and spine fractures. In gout patient, the user of allopurinol or benzbromarone has significantly lower risk of facture than nonusers.Gout history is considered as a risk factor for fractures, particularly in female individuals and fracture sites located at the spine or upper/lower limbs.

Gout is not associated with the risk of fracture: a meta-analysis

“…Numerous quantitatively based studies debating the association between gout and the risk of fractures remain inconclusive. Tzeng et al [23] reported that gout history increased the fracture risk, which was consistent with the results of a Chinese adult-based research conducted by Wang et al [24]. However, the relationship became variable when focus on different fracture sites in the study performed by Paik et al [17], in which the risk of fractures raised in the hip but not in the wrist.…”

“…After 326 studies excluded by duplicates, 2291 excluded by reading titles and abstracts, and 32 studies were downloaded and carefully checked by reading full texts. After careful reading, five articles [1, 17, 23–25] involving eight datasets were considered to be qualified for the quantitative analysis of the association of gout with the risk of fractures, and four articles [1, 23, 26, 28] were considered to be qualified for the quantitative analysis of the association of urate-lowering with the risk of fractures. The inclusion processes and reasons for exclusion were depicted in Fig.…”

“…With regard to the data source, all seven studies [1, 17, 23–26, 28] involved in the participants from the different data source. As for study type, five described retrospective cohort studies [1, 23–26] and two prospective cohort study [17, 28]. Kim et al and Paik et al [17, 25] presented data about the association between gout and fracture risk in two different cohorts based on the fracture localizations.…”

“…Kim et al [25] conducted a large-scale epidemiological study and demonstrated the neutral association between gout and bone health, and Sultan et al [1] reported the similar results in a nationally representative cohort research. Additionally, a population-based study in Taiwan demonstrated a lower fracture risk among gout patients prescribed urate-lowering therapy [23], while a 9% higher risk was found in a Denmark registry-based study [26]. Hence, it was difficult to clarify the associations of gout and its related treatment with the risk of fractures based on these published observational studies.…”

Is fracture risk linked to gout or urate-lowering therapy?

“…This large observational study with long follow-up used data from a nationally representative cohort, and therefore, the findings are likely to be generalisable to a broader population. The finding that there is no link between gout and risk of fragility conflicts with an earlier Taiwanese study that reported a 17% higher risk of fracture in people with gout compared with controls 2. However, the Taiwanese study included all fracture sites (including ankle and foot) rather than only fragility fractures.…”