title: Association of serum uric acid and incident nonspine fractures in elderly men: the Osteoporotic Fractures in Men (MrOS) study.
abstract: Uric acid (UA) is produced from purines by the enzyme xanthine oxidase, and elevated levels may cause arthritis and kidney stones. Conversely, UA also appears to function as an antioxidant and may protect against the oxidative stress associated with aging and disease. We performed a prospective fracture case-cohort study to understand the relation of UA and fracture risk in older men enrolled in the Osteoporotic Fractures in Men (MrOS) study. In the cohort of 5994 men aged 65 years and older attending the baseline MrOS examination, we evaluated a subgroup 1680 men in a case-cohort study design. The analytic group included 387 men with incident nonspine fractures (73 hip) and a random sample of 1383. Serum UA was measured in baseline serum samples. Modified proportional hazards models that account for case-cohort study design were used to estimate the relative hazards (RH) of hip and nonspine fracture in men for serum UA. Models were adjusted for age, race, clinic site, body mass index, vitamin D, parathyroid hormone, walking speed, Physical Activity Scale for the Elderly (PASE) score, frailty, and total. Subjects with incident nonspine fractures were older, had lower total hip bone mineral density (BMD), and higher serum phosphorus. There was an 18% decreased risk of nonspine fractures (95% confidence interval [CI] 0.71-0.93; p = 0.003) per 1 SD increase of baseline serum and 34% decreased risk of nonspine fractures in quartile 4 of UA versus quartiles 1, 2, and 3 (95% CI 0.49-0.89; p = 0.028) compared with nonfracture cases after multivariate adjustment. Hip fractures were not significantly associated with UA. Total hip BMD was significantly higher in the group of men with high UA levels compared with lower UA levels and increased linearly across quartiles of UA after multivariate adjustment (p for trend = 0.002). In summary, higher serum UA levels were associated with a reduction in risk of incident nonspine fractures but not hip fractures and higher hip BMD.
authors.affiliation: University of California at Davis, Sacramento, CA, USA.
authors.forename: Nancy E
authors.initials: NE
authors.lastname: Lane
authors.forename: Neeta
authors.initials: N
authors.lastname: Parimi
authors.forename: Li-Yung
authors.initials: LY
authors.lastname: Lui
authors.forename: Barton L
authors.initials: BL
authors.lastname: Wise
authors.forename: Wei
authors.initials: W
authors.lastname: Yao
authors.forename: Yu-An Evan
authors.initials: YA
authors.lastname: Lay
authors.forename: Peggy M
authors.initials: PM
authors.lastname: Cawthon
authors.forename: Eric
authors.initials: E
authors.lastname: Orwoll
mesh_terms: D000368:Aged; D000493:Allopurinol / Q000627:therapeutic use; D015519:Bone Density; D015331:Cohort Studies; D006073:Gout / Q000150:complications / Q000188:drug therapy; D006620:Hip Fractures / Q000097:blood / Q000150:complications / Q000503:physiopathology; D006801:Humans; D015994:Incidence; D008297:Male; D058866:Osteoporotic Fractures / Q000097:blood* / Q000150:complications / Q000453:epidemiology* / Q000503:physiopathology; D014481:United States / Q000453:epidemiology; D014527:Uric Acid / Q000097:blood*
chemical_list: D014527:Uric Acid; D000493:Allopurinol
keywords: AGING; DXA < ANALYSIS/QUANTITATION OF BONE; EPIDEMIOLOGY