Liu Yani, Feng Jihua, Ji Pan, Chen Wei, Yang Ruiqi, Zhang Jianfeng
Department of General Practice, The Second Affiliated Hospital of Guangxi Medical University, No. 166 Daxuedong Road, 530007, Nanning, China.
Department of General Practice, Affiliated Hospital of Guilin Medical University, 541001, Guilin, China.
Z Rheumatol. 2024 Feb;83(Suppl 1):191-199. doi: 10.1007/s00393-023-01432-4. Epub 2023 Sep 27.
The relationship between gout and osteoporosis is poorly clarified, and the association between gout and fractures incidence remains controversial. Hence, in the present study, we aimed to comprehensively evaluate the available literature to elucidate whether gout is associated with an increased risk of both osteoporosis and fractures.
We conducted an exhaustive search of pertinent literature published until 20 March 2023, in well-recognized databases, namely Medline, Embase and Cochrane Library, focusing on examining the association between gout and the risk of osteoporosis or fracture. Meta-analysis was performed to aggregate the relative risks (RR) using random- or fixed-effects models. Sensitivity analyses were conducted iteratively, whereby each study was removed sequentially to gauge its impact on the overall outcome. Publication bias was assessed using Egger's and Begg's tests. This study was registered with PROSPERO (registry number: CRD42022376822).
Herein, we included 10 observational studies comprising a total of 1,606,095 participants. An independent population sample of four studies validated the significant association between gout and osteoporosis (RR = 1.25, 95% confidence interval [CI] 1.05-1.48), with the results demonstrating robustness. However, our analysis did not detect any association between gout and fracture risk when compared with the control group (RR = 1.09, 95%CI 0.99-1.19), along with high heterogeneity (p for heterogeneity = 0.000; I = 79.7%). Further subgroup analysis revealed that gout is positively associated with fracture risk in the Chinese population (RR = 1.17, 95%CI 1.14-1.21), with no evidence of heterogeneity (p for heterogeneity = 0.420; I = 0.00%).
Our meticulous evaluation of the available literature indicates that gout has no discernible impact on fracture incidence, although it is positively associated with an enhanced risk of osteoporosis. Therefore, it is imperative to prioritize preventive measures to prevent osteoporotic complications in individuals diagnosed with gout.
痛风与骨质疏松症之间的关系尚未完全阐明，痛风与骨折发生率之间的关联仍存在争议。因此，在本研究中，我们旨在全面评估现有文献，以阐明痛风是否与骨质疏松症和骨折的风险增加相关。
我们在知名数据库（即Medline、Embase和Cochrane图书馆）中对截至2023年3月20日发表的相关文献进行了详尽搜索，重点研究痛风与骨质疏松症或骨折风险之间的关联。使用随机效应或固定效应模型进行荟萃分析，以汇总相对风险（RR）。进行了迭代敏感性分析，依次剔除每项研究以评估其对总体结果的影响。使用Egger检验和Begg检验评估发表偏倚。本研究已在PROSPERO注册（注册号：CRD42022376822）。
在此，我们纳入了10项观察性研究，共1,606,095名参与者。四项研究的独立人群样本验证了痛风与骨质疏松症之间的显著关联（RR = 1.25，95%置信区间[CI] 1.05 - 1.48），结果显示具有稳健性。然而，与对照组相比，我们的分析未发现痛风与骨折风险之间存在任何关联（RR = 1.09，95%CI 0.99 - 1.19），且异质性较高（异质性p = 0.000；I = 79.7%）。进一步的亚组分析显示，痛风与中国人群的骨折风险呈正相关（RR = 1.17，95%CI 1.14 - 1.21），且无异质性证据（异质性p = 0.420；I = 0.00%）。
我们对现有文献的细致评估表明，痛风对骨折发生率没有明显影响，尽管它与骨质疏松症风险增加呈正相关。因此，必须优先采取预防措施，以预防痛风患者的骨质疏松并发症。
