Health Management Center, Xiangya Hospital, Central South University, Department of Orthopaedics, Xiangya Hospital, Central South University, and Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, China.
Division of Rheumatology, Allergy, and Immunology, Department of Medicine, and The Mongan Institute, Massachusetts General Hospital, and Harvard Medical School, Boston.
Arthritis Rheumatol. 2023 Aug;75(8):1456-1465. doi: 10.1002/art.42504. Epub 2023 May 25.
Gout is associated with a higher risk of fracture; however, findings on the associations of hyperuricemia and urate-lowering therapy (ULT) with the risk of fracture have been inconsistent. We examined whether lowering serum urate (SU) levels with ULT to a target level (i.e., <360 μmoles/liter) reduces the risk of fracture among individuals with gout.
We emulated analyses of a hypothetical target trial using a "cloning, censoring, and weighting" approach to examine the association between lowering SU with ULT to the target levels and the risk of fracture using data from The Health Improvement Network, a UK primary care database. Individuals with gout who were age 40 years or older and for whom ULT was initiated were included in the study.
Among 28,554 people with gout, the 5-year risk of hip fracture was 0.5% for the "achieving the target SU level" arm and 0.8% for the "not achieving the target SU level" arm. The risk difference and hazard ratio for the "achieving the target SU level" arm was -0.3% (95% confidence interval [95% CI] -0.5%, -0.1%) and 0.66 (95% CI 0.46, 0.93), respectively, compared with the "not achieving the target SU level" arm. Similar results were observed when the associations between lowering SU level with ULT to the target levels and the risk of composite fracture, major osteoporotic fracture, vertebral fracture, and nonvertebral fracture were assessed.
In this population-based study, lowering the SU level with ULT to the guideline-based target level was associated with a lower risk of incident fracture in people with gout.
痛风与骨折风险增加相关；然而，高尿酸血症和降尿酸治疗（ULT）与骨折风险之间的关联的研究结果并不一致。我们研究了通过 ULT 将血清尿酸（SU）水平降低到目标水平（即 <360 μmol/L）是否可以降低痛风患者的骨折风险。
我们使用“克隆、删失和加权”方法模拟假设的目标试验分析，使用英国初级保健数据库 The Health Improvement Network 的数据，检查将 SU 通过 ULT 降低到目标水平与骨折风险之间的关联。纳入年龄在 40 岁或以上且开始接受 ULT 的痛风患者。
在 28554 名痛风患者中，“达到目标 SU 水平”组的 5 年髋部骨折风险为 0.5%，“未达到目标 SU 水平”组为 0.8%。“达到目标 SU 水平”组的风险差异和风险比分别为 -0.3%（95%置信区间 [95%CI]：-0.5%，-0.1%）和 0.66（95%CI：0.46，0.93），与“未达到目标 SU 水平”组相比。当评估将 ULT 降低 SU 水平与目标水平与复合骨折、主要骨质疏松性骨折、椎体骨折和非椎体骨折风险之间的关联时，也观察到了类似的结果。
在这项基于人群的研究中，通过 ULT 将 SU 水平降低到基于指南的目标水平与痛风患者的骨折风险降低相关。
