Gout, Urate-Lowering Therapy Not Associated With Risk for Fragility Fracture

xray of a hip fracture
xray of a hip fracture
The use of urate-lowering therapy in patients with gout had neither beneficial nor adverse effects on long-term fracture risk.

No increased risk for fragility fracture was observed in patients with gout, and the use of urate-lowering therapy in these individuals had neither beneficial nor adverse effects on long-term fracture risk, according to the results of an analysis published in the Canadian Medical Association Journal.

The investigators used data from the Clinical Practice Research Datalink, a large database containing primary care medical records of patients from the United Kingdom, to identify patients with incident gout from 1990 to 2004 who were followed until 2015. Each of the patients with gout was matched with 4 controls, based on age, gender, and general practice. Cox regression models were used to calculate the absolute rate of fracture and hazard ratios (HRs). The effect of urate-lowering therapy on fracture risk was also evaluated in patients with gout.

A total of 31,781 patients with incident gout were identified and matched with 122,961 controls. The absolute rate of fracture was similar in patients with gout and controls (absolute rate, 53 and 55 per 10,000 person-years, respectively), which corresponded to an HR of 0.97 (95% CI, 0.92-1.02). When the analysis was stratified according to age and gender, the findings remained unchanged. No statistically significant differences in risk for fracture were reported in patients who received urate-lowering therapy within 1 and 3 years following their gout diagnosis.

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The investigators concluded that their propensity score-matched analysis demonstrated that prescribing ≥6 months of urate-lowering therapy within 1 and 3 years of patients’ initial diagnosis of gout had neither a beneficial nor an adverse effect on the long-term risk for fracture. Therefore, the findings of this study should be reassuring to patients, healthcare policymakers, and clinicians.

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Sultan AA, Whittle R, Muller S, et al. Risk of fragility fracture among patients with gout and the effect of urate-lowering therapy. CMAJ. 2018;190(19):E581-E587.