Serum urate lowering confers protection against fracture in gout

Among people with gout, reducing serum urate levels to the guideline-based target level appears to contribute to a protective effect on incident fracture, according to a study.

Researchers emulated analyses of a hypothetical target trial using a “cloning, censoring, and weighting” approach to assess whether lowering serum urate levels with urate-lowering therapy (ULT) to a target level (ie, <360 μmol/L) reduced the risk of fracture. Data were obtained from the UK primary care database The Health Improvement Network.

A total of 28,554 individuals with gout who were ≥40 years of age and had initiated ULT were included in the study. The 5-year risk of hip fracture was 0.5 percent in the “achieving the target SU level” arm and 0.8 percent in the “not achieving the target SU level” arm (risk difference, –0.3 percent, 95 percent confidence interval [CI], –0.5 to –0.1).

Compared with the “not achieving the target SU level” arm, the “achieving the target SU level” arm was associated with a 34-percent lower likelihood of developing fracture (hazard ratio, 0.66, 95 percent CI, 0.46–0.93).

Results were similar when the analysis was stratified according to the types of fracture: composite fracture, major osteoporotic fracture, vertebral fracture, and nonvertebral fracture.

The findings suggest that while gout is associated with an increased risk of fracture, ULT may be beneficial.