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Gout and allopurinol adherence in newly diagnosed patients and the risk of fractures: a nationwide cohort study.

Jang Ho Doo·Jiwon Yu·Sun Jae Park·Sang Woo Park·Jina Chung·Ju Hyun Kang·Young Jun Park·Hyun-Young Shin·Changho Han·Byeongzu Ghang·Sang Min Park
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Abstract

INTRODUCTION / OBJECTIVES: The association between gout and fractures remains controversial due to the competing effects of uric acid's antioxidant properties and gout-induced chronic inflammation. Our study aimed to evaluate the risk of fractures in newly diagnosed gout patients and to analyze the impact of Allopurinol medication adherence on this risk. METHODS: This nationwide cohort study utilized the National Health Insurance Service-National Health Screening Cohort (NHIS-HEALS) database (2002-2019). We identified 4,107 patients newly diagnosed with gout who remained on continuous allopurinol therapy during the 24-month medication assessment period and matched them 1:3 with 12,321 non-gout controls using propensity score matching. Allopurinol adherence was assessed via the Medication Possession Ratio (MPR) over a 24-month period and categorized into three groups: MPR&#x2009;<&#x2009;0.3, 0.3&#x2009;&#x2264;&#x2009;MPR&#x2009;<&#x2009;0.8, and MPR&#x2009;&#x2265;&#x2009;0.8. Multivariable Cox proportional hazards regression was used to calculate adjusted hazard ratios (aHR) and 95% confidence intervals (CI) for fractures (vertebral, hip, and distal radius). RESULTS: Gout patients demonstrated a significantly higher risk of overall fractures compared to the non-gout group (aHR 5.52; 95% CI 4.19-7.26). A significant inverse linear relationship was observed between allopurinol adherence and fracture risk (P for trend&#x2009;<&#x2009;.001). The risk was highest in the low-adherence group (MPR&#x2009;<&#x2009;0.3; aHR 5.91; 95% CI 4.40-7.93) and relatively lower in the high-adherence group (MPR&#x2009;&#x2265;&#x2009;0.8; aHR 4.77; 95% CI 2.94-7.72). Consistent trends were observed for vertebral (aHR 5.68) and hip (aHR 4.22) fractures. These associations remained consistent across all subgroups, including age, sex, and comorbidities. CONCLUSION: Newly diagnosed gout is associated with a substantially increased risk of fractures. Higher adherence to Allopurinol therapy is correlated with a significant reduction in this risk, suggesting that consistent urate-lowering therapy may mitigate gout-related bone fragility. Key Points &#x2022; Newly diagnosed gout patients have a significantly higher risk of major osteoporotic fractures compared to the non-gout population. &#x2022; A significant inverse linear relationship exists between Allopurinol adherence and fracture risk, with the highest adherence group (MPR &#x2265; 0.8) showing a relatively lower risk. &#x2022; Consistent urate-lowering therapy (ULT) may mitigate bone fragility in gout patients by reducing systemic inflammatory burden caused by urate crystal deposition.

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HumansAllopurinolGoutFemaleMaleGout SuppressantsMiddle AgedAgedFractures, BoneRisk FactorsCohort StudiesAdultDrug MonitoringTaiwanProportional Hazards ModelsMedication AdherenceMedication adherenceNationwide cohort studyOsteoporotic fracturesUrate-lowering therapyJournal Article

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Jang Ho Doo, Jiwon Yu, Sun Jae Park, Sang Woo Park, Jina Chung, Ju Hyun Kang, Young Jun Park, Hyun-Young Shin, Changho Han, Byeongzu Ghang, Sang Min Park. 2026-07-17. Gout and allopurinol adherence in newly diagnosed patients and the risk of fractures: a nationwide cohort study.. https://doi.org/10.1007/s10067-026-08298-2

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Journal Article resourceAdult subjectAged subjectCohort Studies subjectFemale subjectFractures, Bone subjectHumans subjectJournal Article subjectMale subjectMiddle Aged subjectOsteoporotic Fractures subjectProportional Hazards Models subject

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