Background Gout is the most common type of inflammatory arthritis, affecting 2.4% of adults in the UK and is associated with a number of co-morbidities. Our understanding of the association between gout and fracture risk is limited with previous studies offering conflicting results.
Objectives To determine the risk of fracture among gout patients and assess the potential impact of urate-lowering therapy (ULT) on fracture risk.
Methods Utilising primary care records from Clinical Practice Research Datalink we identified patients with gout between 1990 and 2004 who were followed up until 2015. Each gout patient was individually matched to 5 individuals without gout based on age, sex, and registered practice. Absolute rate (AR) of fracture and hazard ratios (HR) were calculated using Cox regression models. We further stratified our analysis by age, gender and ULT prescription.
Results We matched 35,857 patients with incident gout to 148,407 controls. Overall, we found no increased risk of fracture among gout patients compared to controls. However, men with no evidence of ULT had higher absolute risk of fracture compared to controls (AR=39 versus 26 per 10,000 person-years) corresponding to a 23% (HR=1.23; 95% CI 1.12–1.36) increased risk. The risk was particularly high for vertebral (HR=1.50; 95% CI 1.20–1.87) and wrist fracture (HR=1.45; 95% CI 1.21–1.74). Those treated with ULT had a 12% (HR=0.88; 95% CI 0.79–0.98) lower risk of fracture. Similar findings were not observed for women.
Conclusions We found higher risk of vertebral and wrist fractures among men with gout not prescribed ULT. Those prescribed ULT had lower risk of fracture compared to the general population. Further research is needed to understand the role of ULT in fracture prevention.
Acknowledgements CDM is funded by the National Institute for Health Research (NIHR) Collaborations for Leadership in Applied Health Research and Care West Midlands, the NIHR School for Primary Care Research and a NIHR Research Professorship in General Practice. TH is funded by a NIHR Clinical Lectureship in General Practice and AAS is funded by NIHR Postdoctoral Fellowship. The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health
Disclosure of Interest None declared