title: Serum urate levels and the risk of hip fractures: data from the Cardiovascular Health Study.
abstract: OBJECTIVE
  Uric acid inhibits vitamin D activation experimentally and higher serum urate levels are associated with higher parathyroid hormone levels in humans suggesting a link between uric acid and bone health. We hypothesized that hyperuricemia may increase the risk of fractures in older adults.
  
  
  METHODS
  1963 men and 2729 women ≥65 years of age who participated in the Cardiovascular Health Study and had baseline serum urate levels were included in the study. The primary outcome was incident hip fracture, assessed prospectively through June, 2008 by inpatient and outpatient records. The analysis was stratified by sex a priori.
  
  
  RESULTS
  There was a U-shaped relationship between serum urate levels and hip fractures in men. Men in the lowest and the highest urate quartiles (<4.88 and ≥6.88 mg/dL respectively) had a significantly higher rate of fractures in unadjusted analysis. However, upon multivariate adjustment, only the HR for hip fracture in highest quartile versus the reference remained significant (HR 1.9; 95% C.I. 1.1, 3.1; p value 0.02). High serum urate levels were not associated with hip fractures in women.
  
  
  CONCLUSIONS
  In this large prospective cohort of community-dwelling older adults, increased serum urate levels were associated with an increased risk of hip fractures in men. Further studies are needed to confirm these findings and to understand the mechanisms that underlie them.
authors.affiliation: Division of Renal Diseases and Hypertension, University of Colorado Anschutz Medical Center, Aurora, CO.
authors.forename: Tapan
authors.initials: T
authors.lastname: Mehta
authors.affiliation: Department of Biostatistics, University of Washington, Seattle, WA; Department of Epidemiology, University of Washington, Seattle, WA.
authors.forename: Petra
authors.initials: P
authors.lastname: Bůžková
authors.affiliation: Department of Medicine, Division of Nephrology, Tufts Medical Center, Boston, MA.
authors.forename: Mark J
authors.initials: MJ
authors.lastname: Sarnak
authors.affiliation: Division of Renal Diseases and Hypertension, University of Colorado Anschutz Medical Center, Aurora, CO.
authors.forename: Michel
authors.initials: M
authors.lastname: Chonchol
authors.affiliation: Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA.
authors.forename: Jane A
authors.initials: JA
authors.lastname: Cauley
authors.affiliation: Department of Epidemiology, University of Washington, Seattle, WA.
authors.forename: Erin
authors.initials: E
authors.lastname: Wallace
authors.affiliation: Geriatric Research Education & Clinical Center, Minneapolis VA Health Care System, Minneapolis, MN.
authors.forename: Howard A
authors.initials: HA
authors.lastname: Fink
authors.affiliation: University of California Davis Medical Center, Sacramento, CA.
authors.forename: John
authors.initials: J
authors.lastname: Robbins
authors.affiliation: Division of Renal Diseases and Hypertension, University of Colorado Anschutz Medical Center, Aurora, CO. Electronic address: Diana.Jalal@ucdenver.edu.
authors.forename: Diana
authors.initials: D
authors.lastname: Jalal
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015992:Body Mass Index; D015331:Cohort Studies; D015914:Estrogen Replacement Therapy; D005260:Female; D006306:Health Surveys; D006620:Hip Fractures / Q000097:blood / Q000453:epidemiology*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D011446:Prospective Studies; D012306:Risk; D012737:Sex Factors; D014481:United States / Q000453:epidemiology; D014527:Uric Acid / Q000097:blood*
chemical_list: D014527:Uric Acid
keywords: Bone health; Fractures; Urate