Osteoporotic Fracture, Diagnostic Activity, and Treatment in Patients With Gout

Patients with gout may be at high risk for developing osteoporosis and osteoporotic fractures, but osteoporosis may be under-recognized and inadequately managed for patients with gout. We aimed to describe osteoporotic fractures and diagnosis, dual x-ray absorptiometry utilization, and bone protective therapy patterns in patients with gout and comparator groups.

We conducted a retrospective cohort study using the American College of Rheumatology's Rheumatology Informatics System for Effectiveness registry linked to Medicare claims (2015-2021), with 1:1 exact matching (age ±2 years, sex, race, and enrollment quarter) to comparator patients with osteoarthritis (OA) and soft tissue rheumatism (STR). The sample size was determined by including all patients eligible for the study after removing those with exclusionary criteria (eg, inconsistent age or sex and immunomodulation during the baseline period). We examined medications, laboratory test results, bone protective therapies, and computed crude and adjusted incidence rates (IRs) and IR ratios (IRRs) for osteoporotic fractures.

Only 5% of patients with gout used bone protective therapy at baseline, compared to 11.8% of patients with OA. Baseline osteoporotic fracture and osteoporosis diagnosis prevalence was 1.4% and 7.1% in patients with gout versus 2.6% and 15.4% in patients with OA. Approximately 9.0% of patients with gout and 23.2% of patients with STR used bone protective therapy at baseline. Baseline osteoporotic fracture and osteoporosis diagnosis prevalence was 1.9% versus 10.9% in patients with OA and 3.4% versus 30.7% in patients with STR. Higher nonvertebral osteoporotic fracture rates were observed in patients with gout compared to those with OA (IRR 1.4 [95% confidence interval (CI) 1.1-1.8]) and STR (IRR 2.0 [95% CI 1.3-3.1]). Bone protective therapies were infrequently used during follow-up (patients with gout 2.0% vs OA 4.5%; patients with gout 3.4% vs STR 10.3%).

Patients with gout experienced greater rates of osteoporotic fracture and greater osteoporotic fracture risk factors (eg, chronic kidney disease and greater glucocorticoid use) compared to patients with OA and STR yet were less likely to receive bone protective therapies.