In the Journals

Gout not linked to increased risk for bone fracture

Gout is not associated with an increased risk for bone fracture, and urate-lowering drugs had no effect on long-term fracture risk, according to findings published in the Canadian Medical Association Journal.

“It has been hypothesized that, in common with other chronic inflammatory arthritides such as rheumatoid arthritis and spondyloarthropathy, gout may be associated with an increased risk of fracture, primarily owing to the negative effects of chronic inflammation on bone, because proinflammatory cytokines are known to induce bone loss,” Alyshah Abdul Sultan, PhD, of the Arthritis Research UK Primary Care Center, and colleagues wrote. “However, the effects of serum urate on bone health are still under debate, and previous studies that have assessed the impact of gout and urate-lowering therapy on fracture risk have provided conflicting results.”

To study the risk for fracture among individuals with gout, the researchers drew data from the Clinical Practice Research Datalink, which contains primary care records of anonymized patients in the United Kingdom. According to the researchers, the database is representative of the general U.K. population in terms of age, sex, ethnicity and lifestyle.

From the database, Sultan and colleagues identified 31,781 patients with incident gout from 1990 to 2004, and followed them until 2015. In addition, the patients with gout were matched to 122,961 healthy controls based on age, sex and general practice. The researchers then used Cox regression models to determine the absolute rate of fracture and hazard ratios, and analyzed the impact urate-lowering drugs had on fracture risk. They used landmark analysis and propensity score matching to account for immortal time bias and confounding by indication.

In contrast to previous studies, new research found that gout is not linked to an increased risk for bone fracture.
Credit: Shutterstock

According to Sultan and colleagues, the absolute rate of fracture was similar in both groups: 53 per 10,000 person-years for patients with gout and 55 per 10,000 person-years for the healthy controls (HR = 0.97; 95% CI, 0.92–1.02). This remained unchanged when the researchers stratified their findings by age and sex, they wrote. In addition, they did not report any statistically significant differences in the risk for fracture among those treated with urate-lowering medication within 1 and 3 years after diagnosis.

“We found no excess risk of fragility fractures among patients with gout,” Sultan and colleagues wrote. “Our findings remained consistent when we stratified our analysis by age, sex and fracture site. Our propensity score–matched landmark analyses showed that prescription of at least 6 months of urate-lowering therapy within 1 and 3 years of patients’ initial diagnosis of gout had neither beneficial nor adverse effects on long-term risk of fracture. These findings should be reassuring to patients, health care policymakers and clinicians.” – by Jason Laday

Disclosure: Sultan reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.

Gout is not associated with an increased risk for bone fracture, and urate-lowering drugs had no effect on long-term fracture risk, according to findings published in the Canadian Medical Association Journal.

“It has been hypothesized that, in common with other chronic inflammatory arthritides such as rheumatoid arthritis and spondyloarthropathy, gout may be associated with an increased risk of fracture, primarily owing to the negative effects of chronic inflammation on bone, because proinflammatory cytokines are known to induce bone loss,” Alyshah Abdul Sultan, PhD, of the Arthritis Research UK Primary Care Center, and colleagues wrote. “However, the effects of serum urate on bone health are still under debate, and previous studies that have assessed the impact of gout and urate-lowering therapy on fracture risk have provided conflicting results.”

To study the risk for fracture among individuals with gout, the researchers drew data from the Clinical Practice Research Datalink, which contains primary care records of anonymized patients in the United Kingdom. According to the researchers, the database is representative of the general U.K. population in terms of age, sex, ethnicity and lifestyle.

From the database, Sultan and colleagues identified 31,781 patients with incident gout from 1990 to 2004, and followed them until 2015. In addition, the patients with gout were matched to 122,961 healthy controls based on age, sex and general practice. The researchers then used Cox regression models to determine the absolute rate of fracture and hazard ratios, and analyzed the impact urate-lowering drugs had on fracture risk. They used landmark analysis and propensity score matching to account for immortal time bias and confounding by indication.

In contrast to previous studies, new research found that gout is not linked to an increased risk for bone fracture.
Credit: Shutterstock

According to Sultan and colleagues, the absolute rate of fracture was similar in both groups: 53 per 10,000 person-years for patients with gout and 55 per 10,000 person-years for the healthy controls (HR = 0.97; 95% CI, 0.92–1.02). This remained unchanged when the researchers stratified their findings by age and sex, they wrote. In addition, they did not report any statistically significant differences in the risk for fracture among those treated with urate-lowering medication within 1 and 3 years after diagnosis.

“We found no excess risk of fragility fractures among patients with gout,” Sultan and colleagues wrote. “Our findings remained consistent when we stratified our analysis by age, sex and fracture site. Our propensity score–matched landmark analyses showed that prescription of at least 6 months of urate-lowering therapy within 1 and 3 years of patients’ initial diagnosis of gout had neither beneficial nor adverse effects on long-term risk of fracture. These findings should be reassuring to patients, health care policymakers and clinicians.” – by Jason Laday

Disclosure: Sultan reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.