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Gout as a risk factor for osteoporosis: epidemiologic evidence from a population-based longitudinal study involving 108,060 individuals

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Abstract

Summary

Is gout a risk factor for future osteoporosis? This large population-based study comprising two matched groups of individuals with and without gout demonstrates that patients with gout have a 20% increase in the risk of developing osteoporosis in future through an 8-year follow-up.

Introduction

To examine if gout is associated with an increased risk of osteoporosis.

Methods

We conducted a nationwide population-based retrospective matched-cohort study. Two matched cohorts (n = 36,458 with gout and 71,602 without gout) assembled and recruited from the Longitudinal Health Insurance Dataset containing 1 million subjects. Exclusion criteria were missing data, age < 20 years, short follow-up period, and pre-existing osteoporosis. Both cohorts were followed up until incident osteoporosis, death, or the end of the study. Person-year data and incidence rates were evaluated. A multivariable Cox model was used to derive an adjusted hazard ratio (aHR) after controlling for socioeconomic proxy, geographical difference, glucocorticoid and allopurinol exposure, various prespecified medical conditions, and comorbidities.

Results

Men comprised 72.8% of the cohorts. With a follow-up of 183,729 and 359,900 person-years for the gout and non-gout cohorts, 517 and 811 incidents of osteoporosis occurred, respectively, after excluding osteoporosis incidents in the first 3 years of follow-up. The cumulative incidence of osteoporosis was statistically higher in the gout cohort than in the non-gout cohort, at 3.3 versus 2.1% (P = 0.0036, log-rank). Our Cox model showed a 1.2-fold increase in the incidence of osteoporosis in the gout cohort, with an aHR of 1.2 (95% confidence interval, 1.06–1.35).

Conclusions

This first population-based epidemiologic study supports the hypothesis that compared with individuals without gout; those with gout have a modest increase in the risk of developing osteoporosis in future.

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Acknowledgements

The authors are grateful to the National Health Insurance Administration, Ministry of Health and Welfare, Taiwan, and the National Health Research Institute, Taiwan, for kindly providing access to the research data for this study. The interpretation and conclusions contained herein do not represent those of the institutions above.

Author information

Authors and Affiliations

  1. Department of Internal Medicine, Kuang Tien General Hospital, 117 Sha-Tien Road, Taichung, 43303, Taiwan

    V. C. Kok

  2. Disease Informatics Research Group, Asia University Taiwan, Taichung, 41354, Taiwan

    V. C. Kok & J.-T. Horng

  3. Department of Computer Science and Information Engineering, National Central University, Taoyuan, 32001, Taiwan

    J.-T. Horng & Z.-Y. Chen

  4. Department of Orthopedic Surgery, Kuang Tien General Hospital, Tachia, Taichung, 43761, Taiwan

    M. N. Wang

  5. College of Medicine & Nursing, Hungkuang University, Taichung, 43302, Taiwan

    M. N. Wang

  6. Division of Biostatistics, Institute of Public Health, School of Medicine, National Yang-Ming University, Taipei, 11221, Taiwan

    J.-T. Kuo

  7. Division of Rheumatology, Immunology, and Allery, Department of Internal Medicine, Kuang Tien General Hospital, Taichung, 43303, Taiwan

    G.-D. Hung

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  1. V. C. Kok
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Corresponding author

Correspondence to V. C. Kok.

Ethics declarations

This research was initiated after obtaining approval from the Kuang Tien General Hospital Institutional Review Board with the certificate number KTGH IRB-10449. This study also strictly adhered to confidentiality guidelines that are in accordance with the regulations set forth by the Taiwan Personal Information Protection Act. The research was conducted in accordance with the Declaration of Helsinki, as revised in 1989. The IRB has waived the need to obtain a written informed consent from the patients.

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Kok, V.C., Horng, JT., Wang, M.N. et al. Gout as a risk factor for osteoporosis: epidemiologic evidence from a population-based longitudinal study involving 108,060 individuals. Osteoporos Int 29, 973–985 (2018). https://doi.org/10.1007/s00198-018-4375-2

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  • DOI: https://doi.org/10.1007/s00198-018-4375-2

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