{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,29]],"date-time":"2026-10-29T20:53:04Z","timestamp":1793307184637,"version":"4.5.0"},"reference-count":27,"publisher":"Springer Science and Business Media LLC","issue":"9","license":[{"start":{"date-parts":[[2026,7,17]],"date-time":"2026-07-17T00:00:00Z","timestamp":1784246400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,7,17]],"date-time":"2026-07-17T00:00:00Z","timestamp":1784246400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"name":"Seoul National University","id":[{"id":"https:\/\/ror.org\/04h9pn542","id-type":"ROR","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Clin Rheumatol"],"published-print":{"date-parts":[[2026,9]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction \/ Objectives<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This nationwide cohort study utilized the National Health Insurance Service-National Health Screening Cohort (NHIS-HEALS) database (2002\u20132019). 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\u2009&lt;\u20090.3, 0.3\u2009\u2264\u2009MPR\u2009&lt;\u20090.8, and MPR\u2009\u2265\u20090.8. 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).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Gout patients demonstrated a significantly higher risk of overall fractures compared to the non-gout group (aHR 5.52; 95% CI 4.19\u20137.26). A significant inverse linear relationship was observed between allopurinol adherence and fracture risk (P for trend\u2009&lt;\u2009.001). The risk was highest in the low-adherence group (MPR\u2009&lt;\u20090.3; aHR 5.91; 95% CI 4.40\u20137.93) and relatively lower in the high-adherence group (MPR\u2009\u2265\u20090.8; aHR 4.77; 95% CI 2.94\u20137.72). 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>\n                      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.\n                      <jats:table-wrap>\n                        <jats:table>\n                          <jats:tbody>\n                            <jats:tr>\n                              <jats:td align=\"left\" colspan=\"2\">\n                                <jats:bold>Key Points<\/jats:bold>\n                                <jats:italic>\u2022 Newly diagnosed gout patients have a significantly higher risk of major osteoporotic fractures compared to the non-gout population.<\/jats:italic>\n                                <jats:italic>\u2022 A significant inverse linear relationship exists between Allopurinol adherence and fracture risk, with the highest adherence group (MPR \u2265 0.8) showing a relatively lower risk.<\/jats:italic>\n                                <jats:italic>\u2022 Consistent urate-lowering therapy (ULT) may mitigate bone fragility in gout patients by reducing systemic inflammatory burden caused by urate crystal deposition.<\/jats:italic>\n                              <\/jats:td>\n                            <\/jats:tr>\n                          <\/jats:tbody>\n                        <\/jats:table>\n                      <\/jats:table-wrap>\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s10067-026-08298-2","type":"journal-article","created":{"date-parts":[[2026,7,17]],"date-time":"2026-07-17T08:01:47Z","timestamp":1784275307000},"page":"5749-5758","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Gout and allopurinol adherence in newly diagnosed patients and the risk of fractures: a nationwide cohort study"],"prefix":"10.1007","volume":"45","author":[{"given":"Jang Ho","family":"Doo","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jiwon","family":"Yu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sun Jae","family":"Park","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sang woo","family":"Park","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jina","family":"Chung","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ju Hyun","family":"Kang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Young Jun","family":"Park","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hyun-Young","family":"Shin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Changho","family":"Han","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Byeongzu","family":"Ghang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7498-4829","authenticated-orcid":false,"given":"Sang Min","family":"Park","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,7,17]]},"reference":[{"issue":"9","key":"8298_CR1","first-page":"533","volume":"102","author":"KT Clebak","year":"2020","unstructured":"Clebak KT, Morrison A, Croad JR (2020) Gout: rapid evidence review. 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The study protocol was approved by the Institutional Review Board (IRB) of Seoul National University Hospital (IRB No. E-2511\u2013032\u20131688).","order":1,"name":"Ethics","label":"Ethics statement","group":{"name":"EthicsHeading","label":"Compliance with ethical standards"}},{"value":"This study was performed in accordance with the ethical standards of the institutional and\/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.","order":2,"name":"Ethics","label":"Human and animal rights","group":{"name":"EthicsHeading","label":"Compliance with ethical standards"}},{"value":"Due to the retrospective nature of this study utilizing anonymized database records, the requirement for informed consent was waived by the Institutional Review Board of Seoul National University Hospital.","order":3,"name":"Ethics","label":"Informed consent","group":{"name":"EthicsHeading","label":"Compliance with ethical standards"}},{"value":"None.","order":4,"name":"Ethics","label":"<b>Disclosures<\/b>","group":{"name":"EthicsHeading","label":"Compliance with ethical standards"}}]}}