Osteoporotic fracture, diagnostic activity, and treatment in patients with gout

BACKGROUND: Patients with gout may be at high risk for developing osteoporosis and osteoporotic fractures, but osteoporosis may be under-recognized and inadequately managed for patients with gout. We aimed to describe osteoporotic fractures and diagnosis, DXA utilization, and bone protective therapy patterns in patients with gout and comparator groups. METHODS: We conducted a retrospective cohort study using the ACR RISE registry linked to Medicare claims (2015-2021), with 1:1 exact matching (age ±2 years, sex, race, enrollment quarter) to osteoarthritis (OA) and soft tissue rheumatism (STR) comparator patients. The sample size was determined by including all patients eligible for the study after removing those with exclusionary criteria (e.g., inconsistent age/sex and immunomodulation during the baseline period). We examined medications, labs, and bone protective therapies and computed crude and adjusted incidence rates (IRs) and incidence rate ratios (IRRs) for osteoporotic fractures. RESULTS: Only five percent of patients with gout used bone protective therapy at baseline, compared to 11.8% in OA. Baseline osteoporotic fracture and osteoporosis diagnosis prevalence was 1.4% and 7.1% in gout vs. 2.6% and 15.4% in OA patients. Approximately 9.0% of patients with gout and 23.2% with STR used bone protective therapy at baseline. Baseline osteoporotic fracture and osteoporosis diagnosis prevalence was 1.9% vs. 10.9% in OA and 3.4% vs. 30.7% in STR. Higher nonvertebral osteoporotic fracture rates were observed in patients with gout compared to OA (IRR: 1.4, 95% CI: 1.1,1.8) and STR (IRR: 2.0, 95% CI: 1.3,3.1). Bone protective therapies were infrequently used during follow-up (gout: 2.0% vs. OA: 4.5%; gout: 3.4% vs. STR: 10.3%). CONCLUSION: Patients with gout experienced greater rates of osteoporotic fracture and greater osteoporotic fracture risk factors (e.g. chronic kidney disease, greater glucocorticoid use) compared to OA and STR patients yet were less likely to receive bone protective therapies.