TOPLINE

Patients with newly diagnosed gout had a higher risk for fractures than individuals without gout, but higher allopurinol adherence was associated with a relatively lower fracture risk, according to a retrospective analysis of a nationwide South Korean health insurance database.

METHODOLOGY

• Researchers conducted a retrospective cohort study to assess whether patients newly diagnosed with gout had an increased risk for fractures and whether adherence to allopurinol affected this risk.
• They analyzed records from a South Korean national health insurance database and identified adults newly diagnosed with gout between 2004 and 2016 who started allopurinol within 6 months and had a health screening within 2 years before diagnosis.
• After propensity score matching, the final analysis included 4107 patients with gout and 12,321 control individuals without gout. The cohort had a mean age of 60.29 years, and 91.3% were men.
• Adherence to allopurinol was evaluated using the medication possession ratio (MPR) over a 24-month period and was categorized as high (MPR ≥ 0.8), medium (MPR, 0.3 to < 0.8), or low (MPR < 0.3).
• The primary outcome was the incidence of overall fractures (defined as a composite of vertebral, hip, and distal radius fractures) requiring hospitalization for at least 2 days. Follow-up began on the index date (2 years after gout diagnosis) and continued until the occurrence of fracture, death, or December 2019, whichever came first.

TAKEAWAY

• Patients with gout had a higher adjusted risk for the study’s composite major osteoporotic fracture outcome than control individuals (adjusted hazard ratio, 5.52; 95% CI, 4.19-7.26).
• The risk for fractures was 5.91-fold higher among patients with low adherence to allopurinol, 4.88-fold higher among those with medium adherence, and 4.77-fold higher among those with high adherence than among control individuals (P for trend < .001).
• Similar trends were observed for vertebral and hip fractures (P for trend < .001 for both).

IN PRACTICE

“[The] findings highlight that consistent, long-term medication adherence may be essential to reducing the possible fracture burden in gout patients,” the authors of the study wrote.

SOURCE

The study was led by Jang Ho Doo, Seoul National University College of Medicine, Seoul, South Korea. It was published online on July 17, 2026, in Clinical Rheumatology.

LIMITATIONS

Researchers lacked laboratory data on serum levels of uric acid. The severity of gouty arthritis could not be identified. Adherence was assessed on the basis of prescription records; thus, researchers could not confirm whether patients took allopurinol.

DISCLOSURES

The authors did not report any funding source for the study. The authors did not declare any conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.