Tapan Mehta1, Petra Bůžková2, Mark J Sarnak3, Michel Chonchol1, Jane A Cauley4, Erin Wallace5, Howard A Fink6, John Robbins7, Diana Jalal8. 1. Division of Renal Diseases and Hypertension, University of Colorado Anschutz Medical Center, Aurora, CO. 2. Department of Biostatistics, University of Washington, Seattle, WA; Department of Epidemiology, University of Washington, Seattle, WA. 3. Department of Medicine, Division of Nephrology, Tufts Medical Center, Boston, MA. 4. Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA. 5. Department of Epidemiology, University of Washington, Seattle, WA. 6. Geriatric Research Education & Clinical Center, Minneapolis VA Health Care System, Minneapolis, MN. 7. University of California Davis Medical Center, Sacramento, CA. 8. Division of Renal Diseases and Hypertension, University of Colorado Anschutz Medical Center, Aurora, CO. Electronic address: Diana.Jalal@ucdenver.edu.
Abstract
PURPOSE: Uric acid inhibits vitamin D activation experimentally and higher serum urate levels are associated with higher parathyroid hormone levels in humans suggesting a link between uric acid and bone health. We hypothesized that hyperuricemia may increase the risk of fractures in older adults. METHODS: 1963 men and 2729 women ≥65 years of age who participated in the Cardiovascular Health Study and had baseline serum urate levels were included in the study. The primary outcome was incident hip fracture, assessed prospectively through June, 2008 by inpatient and outpatient records. The analysis was stratified by sex a priori. RESULTS: There was a U-shaped relationship between serum urate levels and hip fractures in men. Men in the lowest and the highest urate quartiles (<4.88 and ≥6.88 mg/dL respectively) had a significantly higher rate of fractures in unadjusted analysis. However, upon multivariate adjustment, only the HR for hip fracture in highest quartile versus the reference remained significant (HR 1.9; 95% C.I. 1.1, 3.1; p value 0.02). High serum urate levels were not associated with hip fractures in women. CONCLUSION: In this large prospective cohort of community-dwelling older adults, increased serum urate levels were associated with an increased risk of hip fractures in men. Further studies are needed to confirm these findings and to understand the mechanisms that underlie them.
PURPOSE:Uric acid inhibits vitamin D activation experimentally and higher serum urate levels are associated with higher parathyroid hormone levels in humans suggesting a link between uric acid and bone health. We hypothesized that hyperuricemia may increase the risk of fractures in older adults. METHODS: 1963 men and 2729 women ≥65 years of age who participated in the Cardiovascular Health Study and had baseline serum urate levels were included in the study. The primary outcome was incident hip fracture, assessed prospectively through June, 2008 by inpatient and outpatient records. The analysis was stratified by sex a priori. RESULTS: There was a U-shaped relationship between serum urate levels and hip fractures in men. Men in the lowest and the highest urate quartiles (<4.88 and ≥6.88 mg/dL respectively) had a significantly higher rate of fractures in unadjusted analysis. However, upon multivariate adjustment, only the HR for hip fracture in highest quartile versus the reference remained significant (HR 1.9; 95% C.I. 1.1, 3.1; p value 0.02). High serum urate levels were not associated with hip fractures in women. CONCLUSION: In this large prospective cohort of community-dwelling older adults, increased serum urate levels were associated with an increased risk of hip fractures in men. Further studies are needed to confirm these findings and to understand the mechanisms that underlie them.
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