Raised serum uric acid is associated with higher bone mineral density in a cross-sectional study of a healthy Indian population

Relationship between serum uric acid levels and osteoporosis

Osteoporosis (OP) is a systemic bone disease in which bone density and quality decrease and bone fragility increases due to a variety of causes, making it prone to fractures. The development of OP is closely related to oxidative stress. Uric acid (UA) is the end product of purine metabolism in the human body. Extracellular UA has antioxidant properties and is thought to have a protective effect on bone metabolism. However, the process of UA degradation can lead to intracellular oxidative stress, which together with UA-induced inflammatory factors, leads to increased bone destruction. In addition, UA can inhibit vitamin D production, resulting in secondary hyperparathyroidism and further exacerbating UA-associated bone loss. This review summarizes the relationship between serum UA levels and bone mineral density, bone turnover markers, and so on, in the hope of providing new insights into the pathogenesis and treatment of OP.

Association of serum uric acid levels with bone mineral density and the presence of osteoporosis in Chinese patients with Parkinson's disease: a cross-sectional study

INTRODUCTION

As the population ages, the incidence of osteoporosis among patients suffering from Parkinson's disease (PD) will surge continually, and the ensuing disability from falls is becoming a serious social burden. Due to its antioxidant properties, much literature has indicated the possible ability of serum uric acid (UA) to prevent ageing-related diseases caused by oxidative stress, including osteoporosis and PD. Therefore, this study was for exploring the connection of serum UA levels with bone mineral density (BMD) and the osteoporosis presence in Chinese PD patients.

MATERIALS AND METHODS

A cross-sectional design was used to statistically analyze 42 clinical parameters obtained from 135 patients with PD treated in Wuhan Tongji Hospital during 2020-2022. Multiple stepwise linear regression and multiple logistic regression analyses were constructed for identifying the association of serum UA levels with BMD as well as osteoporosis in PD patients, respectively. With receiver operative characteristic (ROC) curves, the optimal cutoff value was acquired for serum UA in the diagnosis of osteoporosis.

RESULTS

According to the regression analysis adjusted for confounders, serum UA levels in PD patients had positive correlation with BMD at each site and negative correlation with the presence of osteoporosis (P < 0.05 for all). ROC curves determined that the optimal cutoff value for UA to perform well in diagnosing osteoporosis in PD patients was 284.27 μmol/L (P < 0.001).

CONCLUSION

Relatively higher serum UA levels in the physiological range can work as a biomarker of higher BMD, and were strongly linked to lower prevalence of osteoporosis in Chinese PD patients.

Bone mass in Saudi women aged 20-40 years: the association with obesity and vitamin D deficiency

This study describes that low bone density is prevalent in premenopausal Saudi women, especially women of normal weight and vitamin D deficiency. Although BMD is higher in obese young women, this may not be beneficial later in life in conjunction with persistent vitamin D deficiency.

INTRODUCTION

Not attaining peak bone mass is one crucial factor contributing to the risk of developing osteoporosis and suffering fractures in later life. The objectives of this study were to describe the normal range of bone mineral density (BMD) and bone mineral content (BMC) in premenopausal Saudi women in relation to obesity and vitamin D insufficiency.

METHODS

A cross-sectional study involving 312 healthy Saudi women aged 20-40. All women were clinically examined. BMD (g/cm²) and BMC (g) assessed at total body (TB), femoral neck (FN) and lumbar spine (LS) were performed using dual-energy X-ray absorptiometry (DXA). Obesity was defined as BMI ≥ 30 kg/m² and vitamin D deficiency defined as 25(OH)D < 50 nmol/L.

RESULTS

Almost half of the studied women were obese, and the majority (86.2%) were deficient in vitamin D. Mean BMD in TB 1.060 ± 0.091, FN 0.918 ± 0.153 and LS 1.118 ± 0.123 g/cm², while TB-BMC 2077 ± 272 g. When classified by BMI, the proportion with low bone density was 2-3 times higher among the normal weight compared to the obese women, p < 0.001. In the cohort overall, ~ 19% of these young premenopausal women had osteopenia or osteoporosis at the femoral neck, but 26% in normal weight, vitamin D deficient women.

CONCLUSION

This study shows low bone density in premenopausal Saudi women, particularly those with normal weight. While obesity appears to confer some protection against vitamin D deficiency at this age, this is assumed to change in later life.

The paradoxical relation between serum uric acid and outcomes of hip fracture in older patients after surgery: A 1-year follow-up study

BACKGROUND

The relation between serum uric acid and bone metabolism has been reported in many studies, but few studies have focused on serum uric acid and fracture rehabilitation. We aimed to explore the potential relationships between serum uric acid and outcomes of hip fractures.

METHODS

A total of 742 patients with hip fractures who underwent surgeries between December 2017 and February 2021 and met the inclusion criteria were included. The data of male and female patients were analyzed separately. Cox models with different adjusted forms were performed to explore the potential risk factors, and restricted cubic splines were used to determine the nonlinear relationships between serum uric acid and outcomes and optimal cutoff points of serum uric acid. Then, the outcomes were analyzed in the groups divided by cutoff points mentioned above, as well as groups divided by the diagnosis of hyperuricemia or gout.

RESULTS

Cox analysis showed that hyperuricemia or gout was associated with increased death risk, and a typical J-shaped curve was observed in the restricted cubic spline. For male patients, a serum uric acid of high level may relate to a high risk of 6-month (P = .008) and 1-year (P = .016) mortality, and a serum uric acid of low level may predict a poor 6-month free walking ability. For female patients, both a serum uric acid of high level and low level were associated with poor 1-year survival (all P < .05), and a serum uric acid of high level may relate to poor 6-month (P = .001) and 1-year (P = .001) free walking ability.

CONCLUSION

Patients with hyperuricemia or gout or patients with high and low levels of serum uric acid may face poor outcomes of hip fractures.

Does the Presence of Metabolic Syndrome Alter Serum Uric Acid Concentrations, Pain, and Well-Being in Patient with Chronic Musculoskeletal Pain?

Objective: To compare serum uric acid concentrations, pain and well-being in patients having chronic musculoskeletal pain with and without MetS, and investigate cut-off values. Methods: Patients having chronic musculoskeletal pain with (MetS group, n=48) and without MetS (control group, n=52) were included. The serum uric acid concentration, pain intensity, body composition, physical activity level, quality of life, and psychological status were evaluated by a uric acid blood test, Visual Analogue Scale, Bio-impedance Analyzer, International Physical Activity Questionnaire-7 (IPAQ-7), Nottingham Health Profile, and Hospital Anxiety and Depression Scale, respectively. Results: Uric acid level, fat mass, waist/hip ratio were found higher in the MetS group in comparison to the control group (P

Association between higher serum uric acid levels within the normal physiological range and changes of lumbar spine bone mineral density in healthy Chinese postmenopausal women: a longitudinal follow-up study

OBJECTIVES

The aim of this study was to investigate whether higher serum uric acid (SUA) levels within the physiological range were associated with changes in lumbar spine bone mineral density (LBMD) in postmenopausal women without existing lumbar spine osteoporosis after a longitudinal follow-up of 3.09 years, and to further confirm the relationship between SUA and bone mineral density (BMD) in other sites such as femoral neck, total hip, and trochanter at follow-up.

METHODS

A longitudinal study of 175 healthy postmenopausal women without osteoporosis was conducted in Shenyang, China. BMD of the lumbar spine, femoral neck, total hip, and trochanter were measured using dual-energy x-ray absorptiometry at each visit. Pearson's correlation analysis and regression analyses were performed to determine any associations.

RESULTS

There were positive correlations between baseline SUA and BMD of the lumbar spine (P = 0.03), total hip (P = 0.04), and trochanter (P = 0.04). Moreover, higher baseline SUA levels were independently associated with LBMD decline and the odds ratio of the baseline SUA of the third quartile group was 0.12 (95% confidence interval, 0.02-0.70, P < 0.05), with P = 0.23 for the trend in baseline SUA when compared with participants in the lowest, first quartile group after adjustment for many potential confounding variables.

CONCLUSIONS

Higher SUA levels within the normal physiological range were independently associated with decreased LBMD, and SUA levels were positively related to the BMD of the lumbar spine, total hip, and trochanter in healthy Chinese postmenopausal women.

Analyses of the relationship between hyperuricemia and osteoporosis

The aim of the present study was to evaluate the association between hyperuricemia and osteoporosis in a Korean population. Data from participants of the Korean Genome and Epidemiology Study who were ≥ 40 years old were collected from 2004 to 2016. Among 173,209 participants, 11,781 with hyperuricemia (> 7.0 mg/dL in men and > 6.0 mg/dL in women) and 156,580 controls were selected based on serum measurements. Odds ratios (ORs) of osteoporosis between individuals with hyperuricemia and controls were analyzed using a logistic regression model. In the adjusted model, age, sex, income group, body mass index, smoking, alcohol consumption, hypertension, diabetes mellitus, hyperlipidemia history and nutritional intake were adjusted. The adjusted OR (aOR) of osteoporosis was 0.79 [95% confidence interval (CI) = 0.71–0.87, P < 0.001]. In subgroup analyses according to age and sex, statistical significance was observed in men > 60 years old and in women > 50 years old. In another subgroup analysis according to past medical history, significant differences were found according to hypertension (aOR = 0.83, 95% CI = 0.73–0.94, and 0.75, 95% CI = 0.64–0.87), diabetes mellitus (aOR = 0.77, 95% CI = 0.69–0.86), and hyperlipidemia (aOR = 0.74, 95% CI = 0.61–0.89, and 0.81, 95% CI = 0.72–0.91). This study demonstrated that hyperuricemia was associated with a decreased risk of osteoporosis.

Association between serum uric acid and bone mineral density in patients with type 2 diabetes: A 6-year longitudinal study in China

The relationship between serum uric acid (UA) and bone mineral density (BMD) has been proposed by several researchers. However, there has been no consensus regarding the relationships among serum UA, diabetes, and BMD. The aim of this study is to investigate the association between UA, BMD, and at least osteopenia in type 2 diabetes patients.This research was a longitudinal study performed at Xiao-Tang-Shan Hospital in Beijing. Type 2 diabetes diagnosis was consistent with the WHO standard classification. Participants with osteopenia or osteoporosis documented by dual-energy X-ray absorptiometry were defined as having "at least osteopenia." A generalized additive model and multivariable logistic regressions were performed to explore the relationship between serum UA and at least osteopenia. Receiver operating characteristic analysis was conducted. Propensity score matching was used to verify the correctness of the cutoff point.In total, 3476 type 2 diabetes patients free of any osteopenia-related diseases were recruited in 2012 and followed up to 2018. The general proportions of patients with at least osteopenia in 2018 was 16.46% (572/3476). Serum UA was negatively associated with BMD stratified by sex, age group, and BMI level. Setting the first quartile as the reference, the risk of at least osteopenia in the fourth quartile was significant among all patients (odds ratio [OR]: 0.75; 95% confidence interval [CI]: 0.57, 0.98) and specifically in females (OR: 0.79; 95% CI: 0.43, 0.97), patients aged over 50 years (OR: 0.79; 95% CI: 0.60, 0.97) and patients with a BMI greater than 25 (OR: 0.74; 95% CI: 0.47, 0.97). The optimal cutoff point for the serum UA level to distinguish at least osteopenia in diabetic patients was 395 μmol/L.Serum UA concentration is negatively associated with the occurrence of at least osteopenia in Chinese patients with type 2 diabetes.

Serum Uric Acid Level Is Positively Associated With Higher Bone Mineral Density at Multiple Skeletal Sites Among Healthy Qataris

BACKGROUND

Oxidative stress has been implicated as a fundamental mechanism in the decline of bone mass. Although serum uric acid (SUA) has potent antioxidant properties, the findings of many epidemiological and experimental studies couldn't draw a clear conclusion on the relation between SUA and bone health. We aim to investigate the association between SUA and bone mineral density (BMD) at different skeletal sites among healthy Qataris.

METHODOLOGY

A cross-sectional analysis including total-body and site-specific bone mineral density scores and other serological markers of 2981 healthy Qatari adults (36.4 ± 11.1 years) from the Qatar biobank database was conducted. The study participants were divided into quartiles based on the level of SUA, and the BMD was measured using dual-energy X-ray absorptiometry (DXA). Multiple regression analyses were applied to investigate the association between SUA and BMD adjusting for multiple confounding factors.

RESULTS

High levels of SUA were significantly associated with the increased bone mineral density of the total body and at site-specific skeletal locations after adjusting for age and gender (p-value < 0.001). Further adjustment for body mass index (BMI), smoking, vitamin D, alkaline phosphatase, and estimated glomerular filtration rate (eGFR) levels attenuated the association but the association remained significant for individuals with high SUA levels (p-value ≤ 0.01).The association between SUA and BMD was not significant in non-obese, females, young adults, and smokers. However, no interaction was found between SUA and age, gender, BMI and smoking.

CONCLUSION

Higher SUA levels are associated with a high bone density among healthy Qatari adults. However, such observation demands further investigations to outline the underlying mechanisms.

Association of Serum Uric Acid Status With Bone Mineral Density in Adolescents Aged 12-19 Years

Aims: Evidence linking serum uric acid (sUA) and bone mineral density (BMD) in adolescents is very limited. To the best of our knowledge, only one report has focused on the relationship between sUA and BMD in adolescents. Thus, this study aimed to determine the association between sUA and total BMD in adolescents aged 12-19 years. Methods: A cross-sectional study was conducted on a sample composed of non-institutionalized US population from the National Health and Nutrition Examination Survey. Weighted multivariate linear regression models were used to evaluate the association between sUA and total BMD. Subgroup analyses were further performed. Results: sUA positively correlated with total BMD in the multiple regression model after adjusting for potential confounders. However, in the subgroup analyses stratified by sex, age, or race/ethnicity, the association between sUA and total BMD followed an inverted U-shaped curve in female adolescents, adolescents aged 16-19 years, and other race/ethnicity. Conclusions: Our results suggested that the correlation between sUA level and total BMD differed by sex. The increased sUA level would be beneficial to bone health in adolescents with low sUA levels, but for female adolescents, a higher sUA level (turning point, 3.9 mg/dL) may have an adverse effect on bone health.

Specific higher levels of serum uric acid might have a protective effect on bone mineral density within a Chinese population over 60 years old: a cross-sectional study from northeast China

Background and objective: Oxidative stress has been demonstrated to be a mechanism that leads to bone mass reduction, and according to many studies, serum uric acid (UA) is a strong endogenous antioxidant that can protect bone mineral density (BMD). To date, there have been no large-scale, cross-sectional studies based on the population in northeast China to assess the relationship between serum UA and BMD. Therefore, we examined the association between serum UA and BMD among a Chinese population older than 60 years old in northeast China.

Methods: This research was a cross-sectional study of 3465 Chinese individuals over 60 years old in nine communities from the city of Shenyang, which is the capital of northeast China’s Liaoning Province. Participants were stratified into three groups by serum UA or BMD levels, and then Pearson’s correlation analysis and multiple regression analysis were used to study the relationship between serum UA and BMD.

Results: We found that participants with higher serum UA levels had significantly greater BMD and T-values compared to those of participants with lower serum UA levels. After adjusting for confounding factors, Pearson’s correlation analysis and multiple regression analysis showed that higher serum UA levels remained associated with higher BMD levels (P<0.05). In different models, the prevalence of osteoporosis (OP) among participants with higher serum UA levels was reduced by 23% to 26% (P<0.05) compared to that in individuals with lower serum UA levels. In addition, serum UA levels were negatively correlated with estimated glomerular filtration rate (eGFR) and positively correlated with 25-hydroxy vitamin D₃ [25-(OH)D₃] (P<0.05).

Conclusion: We concluded that higher serum UA levels are associated with greater BMD, and serum UA might have a protective effect on bone metabolism due to its antioxidant properties.

Review of the Literature Examining the Association of Serum Uric Acid with Osteoporosis and Mechanistic Insights into Its Effect on Bone Metabolism

Background And Objective:

Osteoporosis is a common bone disorder that increases susceptibility to fragility bone fractures. The clinical and public health repercussions of osteoporosis are huge due to the morbidity, mortality, and cost of medical care linked with fragility fractures. Clinical assessment of osteoporotic risk factors can help to identify candidates at an early stage that will benefit from medical intervention and potentially lowering the morbidity and mortality seen with fractures and complications. Given this, research is ongoing to evaluate the association of osteoporosis with some novel or less well-studied risk factors/bio-markers such as uric acid (UA).

Discussion:

Uric acid’s antioxidant activity has been proposed to be one of the factors responsible for increasing longevity and lowering rates of age-related cancers during primate evolution, the level of which increased markedly due to loss of uricase enzyme activity (mutational silencing). Accumulated evidence shows that oxidative stress is the fundamental mechanism of age-related bone loss and acts via enhancing osteoclastic activity and increasing bone resorption. Antioxidant substances such as ascorbic acid scavenge free radicals are positively related to bone health. Thus, it is hypothesized that uric acid holds bone-protective potential owing to its potent antioxidative property. Several correlation studies have been conducted globally to investigate the relationship between serum uric acid with bone mineral density and osteoporosis. Few pre-clinical studies have tried to investigate the interaction between uric acid and bone mineral density and reported important role played via Runt-related transcription factor 2 (RUNX2)/core-binding factor subunit alpha-1 (CBF-alpha-1), Wingless-related integration site (Wnt)-3a/β-catenin signaling pathway and 11β Hydroxysteroid Dehydrogenase type 1.

Conclusion:

In this review, the authors provided a comprehensive summary of the literature related to association studies reported in humans as well work done until date to understand the potential cellular and molecular mechanisms that interplay between uric acid and bone metabolism.

Aerobic interval exercise improves renal functionality and affects mineral metabolism in obese Zucker rats

Obesity, metabolic syndrome, and renal injury are considered risk factors for type 2 diabetes, as well as kidney disease. Functional and structural changes in the kidney as consequence of obesity and metabolic syndrome may lead to impaired mineral metabolism in what is known as chronic kidney disease-mineral and bone disorder. Lifestyle interventions such as physical activity are good strategies to manage these pathologies and therefore, prevent the loss of kidney functionality and related complications in mineral metabolism. In this study, we have used 40 male Zucker rats that were randomly allocated into four different experimental groups, two of them (an obese and a lean one) performed an aerobic interval training protocol, and the other two groups were sedentary. At the end of the experimental period (8 wk), urine, plasma, and femur were collected for biochemical and mineral composition analysis, whereas the kidney was processed for histological studies. The obese rats exhibited albuminuria, glomerulosclerosis, and hypertrophy in glomeruli and renal tubule in some areas, together with alterations in mineral content of plasma but not of femur. The training protocol prevented the generation of albuminuria and glomerulosclerosis, showing a significant action on plasma and bone mineral levels. Therefore, the specific training protocol used in this study was able to prevent the development of diabetic nephropathy and affected the metabolism of certain minerals.

Prevalence of osteoporosis and osteopenia in an apparently healthy Indian population - a cross-sectional retrospective study

OBJECTIVES

An understanding of bone mineral density (BMD) pattern in a population is crucial for prevention and diagnosis of osteoporosis and management of its complications in later life. This study aimed to screen the bone health status and factors associated with osteoporosis in an apparently healthy Indian population.

METHODS

A retrospective review of medical records was done in a tertiary-care hospital for the subjects who had undergone preventive health-check-ups that included BMD measurements at femur-neck, total-femur, and lumbar-spine.

RESULTS

We evaluated 524 subjects (age, 50.0 ± 12.4 years) including 41.2% female and 58.8% male subjects. Osteoporosis was present in 6.9% subjects (female, 11.1%; male, 4.2%) and osteopenia in 34% subjects (female, 40.3%; male, 29.9%). Absolute BMD was higher in male subjects (P < 0.001) compared to female subjects at all bone sites. Prevalence of osteoporosis increased with age in female subjects, but not in male subjects. Osteoporosis rates in the age-groups of 30-39, 40-49, 50-59, 60-69, and ≥70 years were 3%, 3.4%, 14.3%, 18.6%, and 36.4%, respectively in female subjects while prevalence in male subjects was 0%, 4%, 6.5%, 4.3%, and 5.6%, respectively, at lumbar spine. Height (r = 0.234-0.358), weight (r = 0.305-0.388), body mass index (r = 0.143-0.285) and physical activity (r = 0.136-0.153) were positively; and alkaline phosphatase (r = -0.133 to -0.203) was negatively correlated with BMD (all P < 0.01) at all sites. These parameters retained significant correlation after controlling for age and sex. No correlation of serum 25-hydroxy-vitamin-D and calcium was noted with BMD (P > 0.05) at any site.

CONCLUSIONS

Further data on absolute BMD, T scores, and prevalence rates of osteoporosis/osteopenia on multiple bone sites have been presented in this article.