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Original Article
DOI: 10.1016/j.reumae.2021.01.002
Available online 21 July 2021
Risk of osteoporotic thoracic vertebral fractures in patients with gout
Riesgo de fracturas vertebrales dorsales osteoporóticas en pacientes con gota
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Marco Ferrández-Jiméneza, Irene Calabuigb, María-Luisa Peral-Garridob, Miguel Gómez-Garbería, Mariano Andrésa,b,
Corresponding author
drmarianoandres@gmail.com

Corresponding author.
a Departamento de Medicina Clínica, Universidad Miguel Hernández, Alicante, Spain
b Sección de Reumatología, Hospital General Universitario de Alicante, Instituto de Investigación Sanitaria y Biomédica de Alicante, Alicante, Spain
Received 29 September 2020. Accepted 09 January 2021
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Tables (4)
Table 1. Previous published studies which assess the association of gout, osteoporosis and fractures.
Table 2. Clinical characteristics of the study population and comparison by groups of interest. Data shown as n (%), except when specified to the contrary.
Table 3. Clinical characteristics and treatment of group with gout.
Table 4. Multiple logistic regression model for assessing association with the outcome variable (radiographic presence thoracic vertebral fracture).
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Abstract
Objectives

Osteoporosis causes significant morbidity and mortality by the development of fragility fractures, including vertebral fractures. Patients with gout may show an increased risk of osteoporotic fractures, as accelerated bone resorption is likely linked to urate crystal-led inflammatory state. This study aims to evaluate the risk of osteoporotic dorsal vertebral fractures associated with gout.

Methods

Cross-sectional study carried out in patients admitted for cardiovascular events. Patients with available lateral view of chest radiography (on admission or in the previous six months) were selected. Two observers blinded to clinical data reviewed the radiographies simultaneously. Vertebral fracture was defined as a vertebral height loss ≥20%, and presence, number, and severity (by Genant semi-quantitative scale) were registered. To analyse the relationship between gout and the presence of vertebral fractures, the odds ratio (OR) with 95% confidence interval (95%CI) was calculated by multiple logistic regression.

Results

126 patients were analysed, 21 of them (16.67%) suffered from gout. Eighteen cases with fractures were detected, with a prevalence of 14.3%. A significant association was found between gout and vertebral fracture (28.6% gout, 11.4% controls; OR 3.10, 95%CI 1.01–9.52). There were no differences in the number of fractures, while the severity was found to be higher in the controls. The association between gout and vertebral fracture persisted after multivariate adjustment (OR 5.21, 95% CI 1.32−20.61).

Conclusion

An independent association between gout and radiological thoracic vertebral fractures was revealed in patients with a cardiovascular event.

Keywords:
Gout
Inflammation
Osteoporosis
Vertebral fracture
Cardiovascular event
Resumen
Objetivos

La osteoporosis causa gran morbilidad y mortalidad por el desarrollo de fracturas por fragilidad, entre ellas las vertebrales. Los pacientes con gota podrían mostrar un incremento de riesgo de fracturas osteoporóticas debido a una mayor resorción ósea por un estado inflamatorio producido por los cristales de urato. El objetivo de este estudio fue evaluar el riesgo de fracturas vertebrales dorsales osteoporóticas asociado a padecer gota.

Métodos

Estudio transversal realizado con pacientes ingresados por evento cardiovascular. Se seleccionaron pacientes con radiografía torácica lateral reciente al ingreso o en los seis meses previos, que fueron revisadas de forma simultánea por dos observadores desconocedores de los datos clínicos. Se definió fractura vertebral como reducción de la altura vertebral ≥20%, registrando su presencia, número y grado mediante la escala semicuantitativa de Genant. Para analizar la relación entre gota y fractura vertebral, se calculó la odds ratio (OR) con intervalo de confianza al 95% (IC95%) mediante regresión logística múltiple.

Resultados

Seleccionamos 126 pacientes, de los que 21 (16,67%) padecían gota. Se detectaron 18 casos con fracturas, siendo la prevalencia 14,3%. Se encontró una asociación estadísticamente significativa entre gota y fractura vertebral (28,6% gota, 11,4% no gota; OR 3,10, IC95% 1,01–9,52). No hubo mayor número de fracturas por grupos, y la severidad fue superior en los controles. La asociación entre gota y fractura vertebral persistió tras ajuste multivariante (OR 5,21, IC95% 1,32−20,61).

Conclusión

Se ha identificado una asociación independiente entre gota y fracturas vertebrales dorsales radiográficas en pacientes con evento cardiovascular.

Palabras clave:
Gota
Inflamación
Osteoporosis
Fractura vertebral radiológica
Evento cardiovascular

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