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Gout and the Risk of Non‐vertebral Fracture
Author(s) -
Kim Seoyoung C,
Paik Julie M,
Liu Jun,
Curhan Gary C,
Solomon Daniel H
Publication year - 2017
Publication title -
journal of bone and mineral research
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.882
H-Index - 241
eISSN - 1523-4681
pISSN - 0884-0431
DOI - 10.1002/jbmr.2978
Subject(s) - gout , medicine , osteoporosis , hyperuricemia , hazard ratio , inflammatory arthritis , proportional hazards model , uric acid , surgery , physical therapy , arthritis , confidence interval
Prior studies suggest an association between osteoporosis, systemic inflammation, and pro‐inflammatory cytokines such as interleukin (IL)‐1 and IL‐6. Conflicting findings exist on the association between hyperuricemia and osteoporosis. Furthermore, it remains unknown whether gout, a common inflammatory arthritis, affects fracture risk. Using data from a US commercial health plan (2004–2013), we evaluated the risk of non‐vertebral fracture (ie, forearm, wrist, hip, and pelvis) in patients with gout versus those without. Gout patients were identified with ≥2 diagnosis codes and ≥1 dispensing for a gout‐related drug. Non‐gout patients, identified with ≥2 visits coded for any diagnosis and ≥1 dispensing for any prescription drugs, were free of gout diagnosis and received no gout‐related drugs. Hip fracture was the secondary outcome. Fractures were identified with a combination of diagnosis and procedure codes. Cox proportional hazards models compared the risk of non‐vertebral fracture in gout patients versus non‐gout, adjusting for more than 40 risk factors for osteoporotic fracture. Among gout patients with baseline serum uric acid (sUA) measurements available, we assessed the risk of non‐vertebral fracture associated with sUA. We identified 73,202 gout and 219,606 non‐gout patients, matched on age, sex, and the date of study entry. The mean age was 60 years and 82% were men. Over the mean 2‐year follow‐up, the incidence rate of non‐vertebral fracture per 1,000 person‐years was 2.92 in gout and 2.66 in non‐gout. The adjusted hazard ratio (HR) was 0.98 (95% confidence interval [CI] 0.85–1.12) for non‐vertebral fracture and 0.83 (95% CI 0.65–1.07) for hip fracture in gout versus non‐gout. Subgroup analysis ( n = 15,079) showed no association between baseline sUA and non‐vertebral fracture (HR = 1.03, 95% CI 0.93–1.15), adjusted for age, sex, comorbidity score, and number of any prescription drugs. Gout was not associated with a risk of non‐vertebral fracture. Among patients with gout, sUA was not associated with the risk of non‐vertebral fracture. © 2016 American Society for Bone and Mineral Research.