Shen Liusong, Meng Fanqiang, Jiang Qiao, Sheng Junzhi, Feng Haoran, Wang Yuqing, Long Huizhong, Xie Dongxing, Yang Tuo, Ding Xiang, Xiong Yilin
Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, Hunan, China.
Hunan Key Laboratory of Joint Degeneration and Injury, Xiangya Hospital, Central South University, Changsha, Hunan, China.
Int J Rheum Dis. 2025 Jan;28(1):e70013. doi: 10.1111/1756-185X.70013.
Serum uric acid (SUA) may play positive roles in diseases associated with oxidative stress, such as osteoporosis (OP). Nevertheless, the specific impact of SUA levels on both bone mineral density (BMD) and the risk of OP remains uncertain. Considering such information crucial for clinicians when making decisions about urate-lowering therapy (ULT), we sought to fill this gap by conducting dose-response meta-analyses.
PubMed, EMBASE, and Cochrane Library were searched for studies that met the inclusion criteria. Pooled standardized mean difference (SMD) for BMDs and the odds ratio (OR) for OP between the highest and lowest SUA categories as well as the nonlinear dose-response relationships were estimated.
Pooled SMDs indicate that participants in the highest category of SUA have greater BMDs at the lumbar spine (SMD = 0.37; 95% CI: 0.27, 0.46), femoral neck (SMD = 0.25; 95% CI: 0.21, 0.29), total hip (SMD = 0.34; 95% CI: 0.26, 0.42), and lower risk of OP (OR = 0.59, 95% CI: 0.52, 0.67) compared with the lowest. The nonlinear dose-response relationships were also observed. However, when the SUA level exceeded 6 mg/dL, the dose-response curve between SUA levels and the risk of OP tended to be flattened.
Nonlinear dose-response relationships were found that higher SUA levels are associated with greater BMDs and lower risk of OP. For patients receiving ULT, maintaining SUA level at around 6 mg/dL may be appropriate from the perspective of bone metabolism.
血清尿酸（SUA）可能在与氧化应激相关的疾病（如骨质疏松症（OP））中发挥积极作用。然而，SUA水平对骨密度（BMD）和OP风险的具体影响仍不确定。考虑到这些信息对临床医生在做出降尿酸治疗（ULT）决策时至关重要，我们试图通过进行剂量反应荟萃分析来填补这一空白。
检索PubMed、EMBASE和Cochrane图书馆中符合纳入标准的研究。估计最高和最低SUA类别之间BMD的合并标准化均值差（SMD）以及OP的比值比（OR），以及非线性剂量反应关系。
合并的SMD表明，与最低类别相比，SUA最高类别的参与者在腰椎（SMD = 0.37；95%CI：0.27，0.46）、股骨颈（SMD = 0.25；95%CI：0.21，0.29）、全髋（SMD = 0.34；95%CI：0.26，0.42）处有更高的BMD，且OP风险更低（OR = 0.59，95%CI：0.52，0.67）。还观察到非线性剂量反应关系。然而，当SUA水平超过6mg/dL时，SUA水平与OP风险之间的剂量反应曲线趋于平缓。
发现存在非线性剂量反应关系，即较高的SUA水平与更高的BMD和更低的OP风险相关。对于接受ULT的患者，从骨代谢的角度来看，将SUA水平维持在6mg/dL左右可能是合适的。
