Background/Purpose: Serum uric acid (UA) has been postulated to play a role against bone loss due to antioxidant mechanisms. Some studies have shown association between higher UA and greater bone mineral density (BMD). However, there is no data about the relationship between UA and Trabecular Bone Score (TBS), which is a surrogate measure of bone microarchitecture obtained from densitometry (DXA) images of the lumbar spine. TBS represents fracture risk independently of bone density.

Methods: This is a cross-sectional analysis from the Brazilian Longitudinal Study of Adult Health (ELSA-Brazil), which included civil servants aged 35-74 years. We studied a sample (1,362 participants) that was submitted to DXA exams (GE Healthcare Lunar iDXA equipment), including TBS and BMD. Exclusion criteria included: missing UA data; body mass index (BMI) < 15 and > 37 kg/m 2 , estimated glomerular filtration rate (eGFR) < 30 mL/min/1.73 m 2 , excessive alcohol intake, rheumatoid arthritis, malignancy, use of bisphosphonates, beta-blockers, thiazide diuretics, acetylsalicylic acid, corticosteroids, allopurinol. Finally, a total of 766 adults (477 women, 289 men) were yielded for final data analysis (median age, 55 [42-82] years; 60% white). Subjects were categorized into groups based on quartiles of UA level (Q1-4). Multivariate linear regression was employed to assess the association of UA with TBS and BMD (spine, hip, and 1/3 rd radius).

Results: The median age was 54 years (range: 43-82) for men and 56 years (range: 42-81) for women. Median serum uric acid levels were 5.8 mg/dL (range: 2.8-9.5) for men and 4.4 mg/dL (range: 2.0-8.2) for women. After adjusting for multiple potential confounders, no significant differences on TBS were detected when UA was analyzed as continuous variable in males. However, in the categorical analysis, men with UA in the Q2 (5.1- 5.8mg/dL) and Q3 (5.8-6.6) had TBS increased by 0.030 and 0.025, respectively, compared to those in the Q1 (< 5.1). In females, no associations were detected between UA and TBS. Concerning to BMD, no associations were detected between UA as continuous or categorical variable and BMD in males. Conversely, in females, UA as continuous variable was positively associated with lumbar spine BMD only (β 0.161, 95%CI 0.034–0.288, P=0.013; i.e.,BMD increased by 0.161g/cm 2 per each unit increase in UA). But, in the categorical analysis, no differences were detected on BMD across the UA quartile groups in females.

Conclusion: This is the first study to assess the relationship between UA levels and TBS. Our results demonstrated that higher UA was associated with greater TBS in males but not in females, whereas UA was positively related to spine BMD only in females. Taken together, these findings suggest that UA may exert protective effect on bone microarchitecture (TBS) in males and spine BMD in females. Future more prospective studies are needed to further explore the causal relationship of UA with bone health.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/relationship-between-serum-uric-acid-and-trabecular-bone-score-tbs-in-healthy-population/