title: Gout and the Risk of Non-vertebral Fracture.
abstract: 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.
authors.affiliation: Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women's Hospital, Boston, MA, USA.|Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Boston, MA, USA.
authors.forename: Seoyoung C
authors.initials: SC
authors.lastname: Kim
authors.affiliation: Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, MA, USA.|Division of Renal Medicine, Brigham and Women's Hospital, Boston, MA, USA.
authors.forename: Julie M
authors.initials: JM
authors.lastname: Paik
authors.affiliation: Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women's Hospital, Boston, MA, USA.
authors.forename: Jun
authors.initials: J
authors.lastname: Liu
authors.affiliation: Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, MA, USA.|Division of Renal Medicine, Brigham and Women's Hospital, Boston, MA, USA.
authors.forename: Gary C
authors.initials: GC
authors.lastname: Curhan
authors.affiliation: Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women's Hospital, Boston, MA, USA.|Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Boston, MA, USA.
authors.forename: Daniel H
authors.initials: DH
authors.lastname: Solomon
mesh_terms: D015331:Cohort Studies; D005260:Female; D050723:Fractures, Bone / Q000097:blood / Q000453:epidemiology* / Q000209:etiology*; D006073:Gout / Q000097:blood / Q000150:complications*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D014527:Uric Acid / Q000097:blood
chemical_list: D014527:Uric Acid
keywords: COHORT STUDY; FRACTURE; GOUT; URIC ACID