Hyperuricemia protects against low bone mineral density, osteoporosis and fractures: a systematic review and meta-analysis

Background Serum uric acid (SUA) accounts for about 50% of extracellular antioxidant activity, suggesting that hyperuricemia may have a protective role in diseases characterized by high levels of oxidative stress, such as osteoporosis. We aimed to meta‐analyse data regarding bone mineral density (BM...

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Published in:European journal of clinical investigation 2016-11, Vol.46 (11), p.920-930
Main Authors: Veronese, Nicola, Carraro, Sara, Bano, Giulia, Trevisan, Caterina, Solmi, Marco, Luchini, Claudio, Manzato, Enzo, Caccialanza, Riccardo, Sergi, Giuseppe, Nicetto, Davide, Cereda, Emanuele
Format: Article
Language:English
Subjects:
Antioxidants
Biocompatibility
Bone density
Bone Density - physiology
Bone mineral density
Bone turnover
Confidence intervals
Correlation analysis
Data processing
Epidemiologic Methods
Female
Femur
Fractures
Hip
Humans
Hyperuricemia
Hyperuricemia - physiopathology
Male
Meta-analysis
Metabolism
Osteoporosis
Osteoporosis - physiopathology
Osteoporotic Fractures - physiopathology
Oxidative stress
Spine
Surgical implants
Uric acid
Uric Acid - metabolism
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Summary:Background Serum uric acid (SUA) accounts for about 50% of extracellular antioxidant activity, suggesting that hyperuricemia may have a protective role in diseases characterized by high levels of oxidative stress, such as osteoporosis. We aimed to meta‐analyse data regarding bone mineral density (BMD), osteoporosis and fractures in people with higher SUA vs. lower SUA concentrations. Materials and methods Two investigators conducted a literature search using PubMed and Scopus, without language restrictions. Standardized mean differences (SMDs) and 95% confidence intervals (CIs) were used for BMD; risk ratios (RRs) and adjusted odds ratios (ORs) for cross‐sectional data. Most possible adjusted hazard ratios (HRs) were used to assess the association between baseline SUA and incident fractures. Results Of 1405 initial hits, 19 studies were eligible including a total of 55 859 participants. Subjects with higher SUA levels had significantly higher BMD values for the spine (six studies; SMD = 0·29; 95% CI: 0·22–0·35; I2 = 47%), total hip (seven studies; SMD = 0·29; 95% CI: 0·24–0·34; I2 = 33%) and femoral neck (six studies; SMD = 0·25; 95% CI: 0·16–0·34; I2 = 71%). Simple correlation analyses substantially confirmed these findings. An increase of one standard deviation in SUA levels reduced the number of new fractures at follow‐up (three studies; HR = 0·83; 95% CI: 0·74–0·92; I2 = 0%). No significant differences between men and women emerged, although data about women were limited. Conclusions Hyperuricemia was found independently associated with BMD and fractures, supporting a protective role for uric acid in bone metabolism disorders.
ISSN:0014-2972
1365-2362
DOI:10.1111/eci.12677