Target uric acid level in gout patients is associated with a lower incidence of fracture

According to findings published in Arthritis & Rheumatology, patients with gout who attain and maintain target serum urate (SU) levels by urate-lowering treatment (ULT) exhibit a lower risk for fractures.

Dr. Wei and colleagues used data from the Health Improvement Network, a database containing information from patients and doctors in the UK, to investigate the connection between controlled serum urate levels and fracture risk. Gout patients between the ages of 40 and 89 who had been registered in the database for at least a year before participating in the study were included by the researchers. Using at least one diagnostic code to indicate the existence of the disease was used to define gout. The 5-year risk of hip fracture in the “reaching the target SU level” arm among 28,554 gout sufferers was reported as 0.5% and the “not attaining the target SU level” arm was reported as 0.8%, respectively. In comparison to “not achieving the target SU level,” the risk difference and hazard ratio for the “achieving the target SU level” arm were 0.66 and -0.3%, respectively. When the relationships between lowering SU level with ULT to the target levels and the risk of composite fracture, major osteoporotic fracture, vertebral fracture, and non-vertebral fracture were analyzed, similar findings were observed.

An observational cross-sectional pharmacoepidemiologic investigation in 2023 have analyzed the relationship between the ULT treatment status of patients with dyslipidemia, coronary heart disease, heart failure, hypertension, and chronic kidney disease, as well as the relationship between the ULT treatment status of patients and certain clinical laboratory biomarkers. In about 28.9% of people who used ULTs were older and obese with greater rates of chronic kidney disease diagnoses, college graduates or higher, and health insurance coverage. Researchers found that the prevalence of heart failure, coronary heart disease, hypertension, or dyslipidemia did not significantly correlate with ULT use (p > 0.05). High-sensitivity C-reactive Protein levels were lower in ULT recipients compared to non-users (4.74 vs. 7.21 mg/L, p = 0.044). Those who received ULT therapy had significantly decreased low-density lipoprotein and total cholesterol (p < 0.05). Thus, study reported that ULT use among US citizens with gout continues to be modest. The status of patients receiving ULT treatment may be impacted by socioeconomic circumstances. Receiving ULT is also linked to gout risk factors like chronic kidney disease, obesity, and male sex.

Though these results might have been consistent with the recommendations in the guidelines for the use of ULT in chronic kidney disease patients, it is unlikely that obtaining ULT will deteriorate renal function. Beyond decreased urate levels, gout patients getting ULT might also benefit from additional health advantages. To ascertain the long-term effects of ULTs on lipid fractions, renal functions, and other cardiovascular indicators, more investigation is required.


  1. Wei J, Choi HK, Dalbeth N, Lane NE, Wu J, Lyu H, Zeng C, Lei G, Zhang Y. Lowering serum urate with urate‐lowering therapy to target and incident fracture among people with gout. Arthritis & Rheumatology. 2023 Mar 1.
  2. Ortiz-Uriarte M, Betancourt-Gaztambide J, Perez A, Roman YM. Urate-Lowering Therapy Use among US Adults with Gout and the Relationship between Patients’ Gout Treatment Status and Associated Comorbidities. Rheumato. 2023 Feb 3;3(1):74-85.