Department of Orthopedics, Chinese PLA General Hospital, No. 28 Fuxing Road, Beijing, 100853, People's Republic of China.
Osteoporos Int. 2017 Aug;28(8):2299-2307. doi: 10.1007/s00198-017-4059-3. Epub 2017 May 9.
Controversy has arisen in regarding the association between serum uric acid (UA) and fracture risk. Therefore, we conducted a systemic review and meta-analysis by pooling estimate of five prospective studies (29,110 participants). Results showed that an increased serum UA level is associated with a lower risk of fracture. Numerous studies have demonstrated that high serum UA is a relevant risk factor for a wide variety of diseases, whereas new understanding in serum uric acid follows recent reports demonstrating a protective role of UA in health status. However, the association between serum UA and fracture remains controversial. Therefore, we conduct a systemic review and meta-analysis to determine whether elevated UA level is a protective factor for fracture among prospective studies. We searched for studies published before May 6, 2016, using PubMed, Embase, and Cochrane databases, without any language restriction. The inclusion criteria were published studies investigating the association between UA and fractures. Two authors independently screened the retrieved articles in accordance to the predefined inclusion criteria. We pooled the study-specific relative risk estimates using a random-effect model for comparison of persons whose UA levels were in the top tertile with those in the bottom tertile. Factors that may predict these associations were evaluated in subgroup analysis and meta-regression. The five included prospective studies included 29,110 participants. In random-effect models that included all five included studies, the summary hazard ratios (HRs) (top vs bottom tertiles) were 079 (95% CI, 0.69 to 0.89), without evidence of heterogeneity (P for heterogeneity = 0.458; I = 0%). Similar results were shown when pooling estimate of three higher-quality studies (HR 0.80 95% CI, 0.69 to 0.93). The association between UA and fracture remained in sensitivity and subgroup analyses. An increased serum UA level is shown to be associated with a lower risk of fracture, albeit additional large, high-quality prospective studies or a meta-analysis of individual data are still needed to verify the association.
关于血清尿酸（UA）与骨折风险之间的关联存在争议。因此，我们通过汇总五项前瞻性研究（29110 名参与者）的估计值进行了系统评价和荟萃分析。结果表明，血清 UA 水平升高与骨折风险降低相关。许多研究表明，高血清 UA 是多种疾病的相关危险因素，而对血清尿酸的新认识遵循最近的报告，表明 UA 在健康状况中具有保护作用。然而，血清 UA 与骨折之间的关联仍然存在争议。因此，我们进行了系统评价和荟萃分析，以确定在前瞻性研究中升高的 UA 水平是否是骨折的保护因素。我们使用 PubMed、Embase 和 Cochrane 数据库搜索了 2016 年 5 月 6 日之前发表的研究，没有任何语言限制。纳入标准为调查 UA 与骨折之间关系的已发表研究。两位作者根据预先确定的纳入标准独立筛选检索到的文章。我们使用随机效应模型汇总研究特异性相对风险估计值，以比较 UA 水平处于最高三分位的人与处于最低三分位的人。在亚组分析和荟萃回归中评估了可能预测这些关联的因素。纳入的五项前瞻性研究包括 29110 名参与者。在纳入所有五项研究的随机效应模型中，汇总的危险比（HR）（最高与最低三分位）为 0.79（95%CI，0.69 至 0.89），无异质性（P 异质性=0.458；I 2=0%）。当汇总三项更高质量研究的估计值时，也得到了相似的结果（HR 0.80，95%CI，0.69 至 0.93）。UA 与骨折之间的关联在敏感性和亚组分析中仍然存在。结果表明，血清 UA 水平升高与骨折风险降低相关，尽管需要更多的大型、高质量的前瞻性研究或个体数据的荟萃分析来验证这种关联。
