Dataset Information

Gout is not associated with the risk of fracture: a meta-analysis.

ABSTRACT:

Background

Numerous quantitatively based studies measuring the association between gout and the risk of fractures remain inconclusive. In order to determine whether gout could increase the risk of fractures, a meta-analysis was performed systematically.

Methods

Electronic databases, MEDLINE/PubMed, Embase, and Cochrane Library were systematically searched to identify studies evaluating the association of gout and the risk of fractures. No restrictions on language, publication date, or journal of publication were imposed. Meta-analysis was performed to pool the outcome estimates of interest such as fracture incidence, fracture risk, and fracture risk in different sites and at different time points in the follow-up period.

Results

Screening determined that seven studies involving a total of 684,964 participants (151,002 in the gout group and 533,962 in the control group) were deemed viable for inclusion in the meta-analysis. The results of the analysis showed that gout would not significantly have a relatively higher risk of any fracture (RR = 1.11, 95% CI 0.98-1.26). Subgroup analysis showed consistent results for sexuality (female: RR = 1.13, 95% CI 0.93-1.37; male: RR = 0.99, 95% CI 0.91-1.07) and several occurring sites (humerus, wrist, vertebra, hip, upper limbs, and lower limbs). Additionally, the results demonstrated that urate-lowering drugs prescribed early during disease had neither adverse nor beneficial effect on the long-term risk of fractures (RR = 0.89, 95% CI 0.76-1.05).

Conclusions

This meta-analysis confirmed that gout was not associated with an increased risk of fractures. Urate-lowering drugs prescribed early during the course of disease had neither adverse nor beneficial effect on the long-term risk of fractures.

SUBMITTER: Liu F

PROVIDER: S-EPMC6712626 | biostudies-literature | 2019 Aug

REPOSITORIES: biostudies-literature

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Publications

Gout is not associated with the risk of fracture: a meta-analysis.

Liu Fanxiao F Dong Jinlei J Zhou Dongsheng D Kang Qinglin Q Xiong Fei F

Journal of orthopaedic surgery and research 20190827 1

<h4>Background</h4>Numerous quantitatively based studies measuring the association between gout and the risk of fractures remain inconclusive. In order to determine whether gout could increase the risk of fractures, a meta-analysis was performed systematically.<h4>Methods</h4>Electronic databases, MEDLINE/PubMed, Embase, and Cochrane Library were systematically searched to identify studies evaluating the association of gout and the risk of fractures. No restrictions on language, publication date ...[more]

PMID: 31455330

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Project description:Prior studies suggest an association between osteoporosis, systemic inflammation, and pro-inflammatory cytokines such as interleukin (IL)-1 and IL-6. Conflicting findings exist on the association between hyperuricemia and osteoporosis. Furthermore, it remains unknown whether gout, a common inflammatory arthritis, affects fracture risk. Using data from a US commercial health plan (2004-2013), we evaluated the risk of non-vertebral fracture (ie, forearm, wrist, hip, and pelvis) in patients with gout versus those without. Gout patients were identified with ?2 diagnosis codes and ?1 dispensing for a gout-related drug. Non-gout patients, identified with ?2 visits coded for any diagnosis and ?1 dispensing for any prescription drugs, were free of gout diagnosis and received no gout-related drugs. Hip fracture was the secondary outcome. Fractures were identified with a combination of diagnosis and procedure codes. Cox proportional hazards models compared the risk of non-vertebral fracture in gout patients versus non-gout, adjusting for more than 40 risk factors for osteoporotic fracture. Among gout patients with baseline serum uric acid (sUA) measurements available, we assessed the risk of non-vertebral fracture associated with sUA. We identified 73,202 gout and 219,606 non-gout patients, matched on age, sex, and the date of study entry. The mean age was 60 years and 82% were men. Over the mean 2-year follow-up, the incidence rate of non-vertebral fracture per 1,000 person-years was 2.92 in gout and 2.66 in non-gout. The adjusted hazard ratio (HR) was 0.98 (95% confidence interval [CI] 0.85-1.12) for non-vertebral fracture and 0.83 (95% CI 0.65-1.07) for hip fracture in gout versus non-gout. Subgroup analysis (n?=?15,079) showed no association between baseline sUA and non-vertebral fracture (HR?=?1.03, 95% CI 0.93-1.15), adjusted for age, sex, comorbidity score, and number of any prescription drugs. Gout was not associated with a risk of non-vertebral fracture. Among patients with gout, sUA was not associated with the risk of non-vertebral fracture. © 2016 American Society for Bone and Mineral Research.

Project description:IMPORTANCE:Associations between subclinical thyroid dysfunction and fractures are unclear and clinical trials are lacking. OBJECTIVE:To assess the association of subclinical thyroid dysfunction with hip, nonspine, spine, or any fractures. DATA SOURCES AND STUDY SELECTION:The databases of MEDLINE and EMBASE (inception to March 26, 2015) were searched without language restrictions for prospective cohort studies with thyroid function data and subsequent fractures. DATA EXTRACTION:Individual participant data were obtained from 13 prospective cohorts in the United States, Europe, Australia, and Japan. Levels of thyroid function were defined as euthyroidism (thyroid-stimulating hormone [TSH], 0.45-4.49 mIU/L), subclinical hyperthyroidism (TSH <0.45 mIU/L), and subclinical hypothyroidism (TSH ?4.50-19.99 mIU/L) with normal thyroxine concentrations. MAIN OUTCOME AND MEASURES:The primary outcome was hip fracture. Any fractures, nonspine fractures, and clinical spine fractures were secondary outcomes. RESULTS:Among 70,298 participants, 4092 (5.8%) had subclinical hypothyroidism and 2219 (3.2%) had subclinical hyperthyroidism. During 762,401 person-years of follow-up, hip fracture occurred in 2975 participants (4.6%; 12 studies), any fracture in 2528 participants (9.0%; 8 studies), nonspine fracture in 2018 participants (8.4%; 8 studies), and spine fracture in 296 participants (1.3%; 6 studies). In age- and sex-adjusted analyses, the hazard ratio (HR) for subclinical hyperthyroidism vs euthyroidism was 1.36 for hip fracture (95% CI, 1.13-1.64; 146 events in 2082 participants vs 2534 in 56,471); for any fracture, HR was 1.28 (95% CI, 1.06-1.53; 121 events in 888 participants vs 2203 in 25,901); for nonspine fracture, HR was 1.16 (95% CI, 0.95-1.41; 107 events in 946 participants vs 1745 in 21,722); and for spine fracture, HR was 1.51 (95% CI, 0.93-2.45; 17 events in 732 participants vs 255 in 20,328). Lower TSH was associated with higher fracture rates: for TSH of less than 0.10 mIU/L, HR was 1.61 for hip fracture (95% CI, 1.21-2.15; 47 events in 510 participants); for any fracture, HR was 1.98 (95% CI, 1.41-2.78; 44 events in 212 participants); for nonspine fracture, HR was 1.61 (95% CI, 0.96-2.71; 32 events in 185 participants); and for spine fracture, HR was 3.57 (95% CI, 1.88-6.78; 8 events in 162 participants). Risks were similar after adjustment for other fracture risk factors. Endogenous subclinical hyperthyroidism (excluding thyroid medication users) was associated with HRs of 1.52 (95% CI, 1.19-1.93) for hip fracture, 1.42 (95% CI, 1.16-1.74) for any fracture, and 1.74 (95% CI, 1.01-2.99) for spine fracture. No association was found between subclinical hypothyroidism and fracture risk. CONCLUSIONS AND RELEVANCE:Subclinical hyperthyroidism was associated with an increased risk of hip and other fractures, particularly among those with TSH levels of less than 0.10 mIU/L and those with endogenous subclinical hyperthyroidism. Further study is needed to determine whether treating subclinical hyperthyroidism can prevent fractures.

Dataset Information

Gout is not associated with the risk of fracture: a meta-analysis.

Background

Methods

Results

Conclusions

Publications

Gout is not associated with the risk of fracture: a meta-analysis.

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