{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T18:14:29Z","timestamp":1789755269727,"version":"4.0.1"},"reference-count":51,"publisher":"Wiley","issue":"8","license":[{"start":{"date-parts":[[2023,5,25]],"date-time":"2023-05-25T00:00:00Z","timestamp":1684972800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"publisher","award":["81930071"],"award-info":[{"award-number":["81930071"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"publisher","award":["82072502"],"award-info":[{"award-number":["82072502"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"publisher","award":["U21A20352"],"award-info":[{"award-number":["U21A20352"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100004735","name":"Hunan Provincial Natural Science Foundation","doi-asserted-by":"publisher","award":["2022JJ20100"],"award-info":[{"award-number":["2022JJ20100"]}],"id":[{"id":"10.13039\/501100004735","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["acrjournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Arthritis &amp; Rheumatology"],"published-print":{"date-parts":[[2023,8]]},"abstract":"<jats:sec><jats:title>Objective<\/jats:title><jats:p>Gout is associated with a higher risk of fracture; however, findings on the associations of hyperuricemia and urate\u2010lowering therapy (ULT) with the risk of fracture have been inconsistent. We examined whether lowering serum urate (SU) levels with ULT to a target level (i.e., &lt;360 \u03bcmoles\/liter) reduces the risk of fracture among individuals with gout.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We emulated analyses of a hypothetical target trial using a \u201ccloning, censoring, and weighting\u201d approach to examine the association between lowering SU with ULT to the target levels and the risk of fracture using data from The Health Improvement Network, a UK primary care database. Individuals with gout who were age 40\u2009years or older and for whom ULT was initiated were included in the study.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Among 28,554 people with gout, the 5\u2010year risk of hip fracture was 0.5% for the \u201cachieving the target SU level\u201d arm and 0.8% for the \u201cnot achieving the target SU level\u201d arm. The risk difference and hazard ratio for the \u201cachieving the target SU level\u201d arm was \u20130.3% (95% confidence interval [95% CI] \u20130.5%, \u20130.1%) and 0.66 (95% CI 0.46, 0.93), respectively, compared with the \u201cnot achieving the target SU level\u201d arm. Similar results were observed when the associations between lowering SU level with ULT to the target levels and the risk of composite fracture, major osteoporotic fracture, vertebral fracture, and nonvertebral fracture were assessed.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>In this population\u2010based study, lowering the SU level with ULT to the guideline\u2010based target level was associated with a lower risk of incident fracture in people with gout.<\/jats:p><jats:p><jats:boxed-text content-type=\"graphic\" position=\"anchor\"><jats:graphic xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" mimetype=\"image\/png\" position=\"anchor\" specific-use=\"enlarged-web-image\" xlink:href=\"graphic\/art42504-toc-0001-m.png\"><jats:alt-text>image<\/jats:alt-text><\/jats:graphic><\/jats:boxed-text><\/jats:p><\/jats:sec>","DOI":"10.1002\/art.42504","type":"journal-article","created":{"date-parts":[[2023,3,20]],"date-time":"2023-03-20T14:03:00Z","timestamp":1679320980000},"page":"1456-1465","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":16,"title":["Lowering Serum Urate With <scp>Urate\u2010Lowering<\/scp> Therapy to Target and Incident Fracture Among People With Gout"],"prefix":"10.1002","volume":"75","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3510-8241","authenticated-orcid":false,"given":"Jie","family":"Wei","sequence":"first","affiliation":[{"name":"Health Management Center, Xiangya Hospital, Central South University, Department of Orthopaedics, Xiangya Hospital, Central South University, and Department of Epidemiology and Health Statistics Xiangya School of Public Health, Central South University  Changsha China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2862-0442","authenticated-orcid":false,"given":"Hyon K.","family":"Choi","sequence":"additional","affiliation":[{"name":"Division of Rheumatology, Allergy, and Immunology, Department of Medicine, and The Mongan Institute Massachusetts General Hospital, and Harvard Medical School  Boston"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4632-4476","authenticated-orcid":false,"given":"Nicola","family":"Dalbeth","sequence":"additional","affiliation":[{"name":"Department of Medicine University of Auckland  Auckland New Zealand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nancy E.","family":"Lane","sequence":"additional","affiliation":[{"name":"Center for Musculoskeletal Health and Department of Medicine University of California School of Medicine  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