Background/Purpose: Osteoporosis causes significant morbidity and mortality through the development of fragility fractures, including vertebral fractures (VF). Patients with gout may show an increased risk of osteoporotic fractures, as the urate crystals-led inflammatory state has been associated with an accelerated bone resorption, though data to date is conflicting. This field study aims to evaluate the risk of osteoporotic VF associated with gout.

Methods: Patients admitted for cardiovascular events were screened for gout by face-to-face interview following 2015 ACR/EULAR criteria; 40 gout patients, out of the 266 assessed (15%), were identified. Participants with available lateral view of chest radiography (at admission or in the previous six months) were selected for the present analysis (n=126). Two observers, blinded to clinical data and trained by web-based program on VF assessment by the International Osteoporosis Foundation, simultaneously reviewed the radiographies. Presence of VF (defined as height loss ≥20%), number and severity (by Genant semi-quantitative scale), were registered. Chi-squared and Mann-Whitney’s U tests were used for group comparisons. To analyze the relation between gout and presence of VF, odds ratios (OR) with 95% confidence interval (95%CI) were calculated, adjusting for age, female gender and chronic kidney disease by multiple logistic regression.

Results: Chest radiographies from 126 participants were analyzed, 21 of them (16.67%) identified as gout patients. Prevalence of VF in the whole sample was 14.3% (n=18). Results are shown in Table 1. Presence of VF was more frequent in gout patients, while there were no differences in number and severity. Across subgroups, VF numerically predominated in gout at lower age tertile (≤64.0 years: 50.0% vs 5.5%; p=0.184) and in males (23.5% vs 4.1%; p=0.022), compared to controls.

The OR for the presence of VF in gout was 3.10 (95%CI 1.01-9.52), persisting the association after multivariate adjustment (adjusted OR 5.21, 95%CI 1.32-20.61).

Table 1. Vertebral fractures and comparison across subgroups (^#).

Conclusion: An independent association between gout and vertebral fractures at lateral chest radiographies was confirmed in patients with a cardiovascular event. Further studies should confirm this finding in other settings.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/risk-of-vertebral-fractures-at-lateral-chest-radiographies-in-patients-with-gout/