Treat to Target Lowers the Risk of Fracture in Patients with Gout

Worldwide, fractures are a leading cause of morbidity and mortality, especially in the elderly, and previous studies have found an association between gout and the risk of fracture; however, the mechanism linking gout to fracture remains unclear. Wei et al. examined whether lowering serum urate (SU) to a target level (i.e., <360 μmoles/L) is associated with a reduced risk of fracture among individuals with gout.

Methods

The researchers emulated analyses of a hypothetical target trial, using a cloning, censoring and weighting approach, to examine the association between the risk of fracture and lowering SU—with urate-lowering therapy (ULT)—to the target level using data from the U.K.’s Health Improvement Network, a primary care database. Individuals with gout who were age 40 years or older and for whom ULT was initiated were included in the study.

Results

Among 28,554 people with gout, the five-year risk of hip fracture was 0.5% for individuals who achieved the target SU level and 0.8% for those who did not. The risk difference for the group that achieved the target SU level was –0.3% (95% confidence interval [95% CI] –0.5%, –0.1%), and the hazard ratio was 0.66 (95%CI 0.46, 0.93), compared with the group that did not achieve the target SU level. Similar results were observed when the associations between lowering SU level with ULT to the target levels and the risk of composite fracture, major osteoporotic fracture, vertebral fracture and nonvertebral fracture were assessed.

Conclusion

In this population-based study, lowering the SU to the guideline-based target level was associated with a lower risk of incident fracture in people with gout.

For full study details, including source material, refer to the full article. 

Excerpted and adapted from: 

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. 2023 Aug;75(8).