Using ULT to Achieve Target Serum Urate Levels Linked to Lower Fracture Risk in Gout

Lowering serum urate levels with ULT was associated with a lower risk for incident fracture in gout.

In gout, lowering serum urate levels to guideline-specified levels is associated with a lower fracture risk, according to the results of a study published in Arthritis & Rheumatology.

Data for the study were collected from The IQVIA Medical Research Database. Patients with gout aged between 40 and 89 years with at least 1 year of continuous records between 2000 and 2021 were included in the analysis.

Researchers used a cloning, censoring, and weighting approach to evaluate the association between 5-year fracture risk and the use of urate-lowering therapy (ULT) to reach the target serum urate level of less than 360 mmol/L.

The study population (N=28,554) included 23.7% women, with a mean age of 65.3 (SD, 12.0) years, a BMI of 30.3 (SD, 5.6), and a serum urate level of 510.3 (SD, 88.5) mmol/L.

Overall, 8390 patients achieved serum urate targets within 1 year of ULT use. At the end of the 5-year follow-up, serum urate levels were 311.2 mmol/L for those who achieved serum urate control and 454.4 mmol/L for those who did not.

These findings suggest that a “treat-to-target SU level” with ULT may have a beneficial effect on reducing the risk of fracture among people with gout.

In the entire cohort, a total of 62 fractures occurred when urate targets were reached and 108 occurred when targets were not reached. When the urate targets were reached, there was a -0.2% lower risk for fracture over a period of 5 years (hazard ratio [HR], 0.77; 95% CI, 0.61-0.98).

Stratified by type of fracture, achieving vs not achieving urate target levels associated with lower risk for vertebral (HR, 0.59; 95% CI, 0.35-0.97), major osteoporotic (HR, 0.73; 95% CI, 0.58-0.91), composite (HR, 0.87; 95% CI, 0.77-0.99), and nonvertebral (HR, 0.88; 95% CI, 0.77-0.99) fractures.

In addition, reaching target urate was associated with lower incident gout cases (HR, 0.63; 95% CI, 0.43-0.92), initiating allopurinol (HR, 0.64; 95% CI, 0.45-0.92), redefined gout cases (HR, 0.65; 95% CI, 0.45-0.95), and receiving anti-inflammatory treatment (HR, 0.67; 95% CI, 0.47-0.96).

A major limitation of the study was about the lack of access to data on bone mineral density and frailty.

The study authors concluded, “These findings suggest that a ‘treat-to-target [serum urate] level’ with ULT may have a beneficial effect on reducing the risk of fracture among people with gout.”


Wei J, Choi HK, Dalbeth N, et al. Lowering serum urate with urate-lowering therapy to target and incident fracture among people with gout. Arthritis Rheumatol. Published online March 20, 2023. doi:10.1002/art.42504