Well-controlled serum urate levels in gout result in lower fracture risk
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Key takeaways:
- A treat to target serum urate level may have a beneficial effect on reducing fracture risk in patients with gout.
- Hip and composite fracture risks were reduced in patients who achieved serum urate control.
Patients with gout who achieve and maintain target serum urate levels through urate-lowering therapy demonstrate a reduced risk for fractures, according to data published in Arthritis & Rheumatology.
“Gout is the most common inflammatory arthritis and its prevalence and incidence have been increasing overtime,” Jie Wei, MD, PhD, of Xiangya Hospital, in China, and colleagues wrote. “Previous studies have found that gout is associated with a higher risk of fracture; however, the exact mechanism linking gout to fracture remains unclear.”
To investigate the relationship between managed serum urate levels and fracture risk, Wei and colleagues analyzed data from the Health Improvement Network, a database including information from patients and physicians in the United Kingdom. The researchers included patients aged 40 to 89 years with gout who were enrolled in the database for at least 1 year before entering the study. Gout was defined as using at least one diagnostic code signifying the presence of the disease. Patients who started urate-lowering therapy were identified based on the date of the first filled prescription.
The researchers stated they “emulated analyses of a hypothetical target trial using a ‘cloning, censoring and weighting’ approach” to estimate the impact of achieving urate serum stability on the risk for fractures in patients with gout. To accomplish this, they created a dataset including clone information for each patient who initiated urate-lowering therapy and assigned each pair to achieve serum urate control or fail serum urate control. The primary outcome was the occurrence of a hip fracture. Secondary outcomes included the presence of a composite fracture, major osteoporotic fracture, vertebral fracture or a non-vertebral fracture.
The analysis included 28,554 patients with gout. According to the researchers, the 5-year risk for hip fracture occurring in patients who achieved serum urate control was 0.5%, while the risk in patients who did not achieve serum urate control was 0.8%. The risk difference and hazard ratio for those who achieved the target serum urate level was –0.3% (95% CI, 0.5% to –0.1%) and 0.66 (95% CI, 0.46-0.93), respectively, vs. those who failed to achieve target levels.
The researchers additionally noted that the difference in risk was “similar” across the secondary endpoints of composite fracture, major osteoporotic fracture, vertebral fractures and non-vertebral fractures.
“In this large population-based GP electronic health records database from the U.K., lowering [serum urate (SU)] with [urate lowering therapy (ULT)] to target levels (ie, <360 mol/L) among people with gout was associated with a lower risk of hip fracture than not reaching target levels with ULT,” Wei and colleagues wrote. “Similar results were also observed for the risks of composite fracture, major osteoporotic fracture, vertebral fracture, and non-vertebral fracture. These findings suggest that a ‘treat-to-target SU level’ with ULT may have a beneficial effect on reducing the risk of fracture among people with gout.”
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