Association between Serum Uric Acid Levels and Bone Mineral Density in Postmenopausal Women: A Cross-Sectional and Longitudinal Study

Correlation between uric acid levels and bone mineral density in patients with type 2 diabetes mellitus: a systematic review and meta-analysis

Purpose

To explore the controversial relationship between uric acid (UA) levels and bone mineral density (BMD) in patients with type 2 diabetes mellitus (T2DM).

Patients and methods

The PubMed, Embase, and Cochrane Library databases were searched using keywords and related words. Study quality was evaluated using the Newcastle-Ottawa Scale. Studies retrieved in the literature search were systematically screened to extract information and data based on predefined inclusion and exclusion criteria. RevMan version 5.3 and Stata Release 13.0 were used for statistical analysis. Results are expressed as mean difference (MD) and corresponding 95% confidence interval (CI). Heterogeneity was evaluated using the I2 and Q tests.

Results

This meta-analysis included 10 studies comprising 5,717 patients with T2DM. Study quality ranged from moderate to high. Results of comparative analyses were as follows: normal BMD versus (vs.) osteoporosis (OP) in females, MD -13.83 μmol/L (95% CI -41.69 to 14.03); I2 = 7%; P=0.30); normal BMD vs. osteopenia in females, MD -12.41 μmol/L (95% CI -37.81 to 12.99; I2 = 0%; P=0.92); normal BMD vs. abnormal BMD (osteopenia/OP), MD -23.82 μmol/L (95% CI -33.50 to -14.13; I2 = 0%; P=0.44); and osteopenia vs. OP, MD -22.35 μmol/L (95% CI -29.55 to -15.15; I2 = 5%; P=0.39). No publication bias was observed.

Conclusion

Compared with normal BMD, abnormal BMD (osteopenia/OP) was associated with lower UA levels. Compared with osteopenia, OP also showed lower UA.Systematic review registration.

The relationship between uric acid and bone mineral density in the intermediate stage of CKD 1-3

BACKGROUND

Some studies have suggested that uric acid has antioxidant properties that can prevent bone loss, but the relationship between uric acid and bone mineral density is controversial. The aim of this study was to investigate the relationship between UA and BMD in patients with CKD stage 1-3.

METHODS

We extracted 13,047 participants from the NHANES database, including 7342 male subjects and 5705 female subjects. Weighted multiple linear regression analysis was used to investigate the correlation between UA and BMD in patients with CKD stages 1-3.

RESULTS

In patients with CKD stage 1-3, UA was significantly correlated with BMD. In the male group, UA was positively associated with BMD (β, 7.94 [95%CI, 4.95, 10.94]). In the female group, there was a negative relationship between them (β, -5.33 [95%CI, -8.77, -1.89]). The relationship between UA and BMD in male group showed an inverted U-shaped curve, and UA was positively correlated before 6.1 mg/dl and negatively correlated after 6.1 mg/dl. The relationship was basically negative in the female group.

CONCLUSIONS

For the patients with CKD stage 1-3, the relationship between UA and BMD showed an inverted U-shaped curve in the males, while the relationship was largely negative in the females.

BMI mediates the association of serum uric acid with bone health: a cross-sectional study of the National Health and Nutrition Examination Survey (NHANES)

BACKGROUND

The associations between serum uric acid and osteoporosis or osteopenia remain controversial, and few studies have explored whether BMI acts as a mediators in the association between the SUA and OP/ osteopenia.

OBJECTIVE

To explore the relationship between serum uric acid and osteoporosis or osteopenia among US adults.

METHODS

A cross-sectional study was conducted to examine the association between serum uric acid and osteoporosis or osteopenia from four cycles of NHANES. Binary logistic regression models and restricted cubic spline models were used to evaluate the association between serum uric acid and osteoporosis or osteopenia, and interaction analysis was used to test the differences between subgroups. Mediation analysis was utilized to investigate whether BMI acts as a mediator in the association between SUA and OP/ osteopenia.

RESULTS

12581 participants aged ≥ 18 years were included. A U-shape nonlinear relationship between SUA and osteoporosis or osteopenia in all people was found (P < 0.0001, P for nonlinear = 0.0287). There were significant interactions in age subgroups (P for interaction = 0.044), sex subgroups (P for interaction = 0.005), and BMI subgroups (P for interaction = 0.017). We further assessed the subgroups and found the optimal range of serum uric acid levels with a lower risk of osteoporosis or osteopenia was 357-535 µmol/L in males, 327-417 µmol/L in people aged ≥ 50 years, above 309 µmol/L in people aged < 50 years, 344-445 µmol/L in people with BMI ≥ 30, and above 308 µmol/L in people with BMI < 30. BMI fully mediated the association of SUA and OP/osteopenia, with a value of -0.0024(-0.0026--0.0021). These results were robust in sensitivity analyses.

CONCLUSIONS

A complicated relationship between SUA and bone health in different populations was observed. Maintaining SUA within a specific range may be beneficial to bone health. In addition, BMI may play an important role in the association between SUA and bone health, but considering the limitations of this study, further prospective research is required.

Association between serum uric acid and bone mineral density in males from NHANES 2011-2020

Currently, the relationship between serum uric acid (SUA) and bone mineral density (BMD) in men remains controversial. This study aims to investigate the relationship between SUA and lumbar spine BMD in American men using data from the National Health and Nutrition Examination Survey (NHANES). A total of 6254 male subjects aged 12-80 years (mean age 35.52 ± 14.84 years) in the NHANES from 2011 to 2020 were analyzed. SUA was measured by DxC using the timed endpoint method, and lumbar spine BMD was measured by dual-energy X-ray absorptiometry (DXA). Multivariate linear regression models were used to explore the relationship between SUA and BMD by adjusting for age, race/Hispanic origin, drinking behavior, smoking behavior, physical activity, body mass index (BMI), poverty-to-income ratio (PIR), total protein, serum calcium, cholesterol, serum phosphorus, and blood urea nitrogen. After correcting for the above confounders, it was found that SUA was positively associated with lumbar spine BMD in the range of SUA < 5 mg/dL (β = 0.006 95% CI 0.003-0.009, P < 0.001), and BMD of individuals in the highest quartile of SUA was 0.020 g/cm2 higher than those in the lowest quartile of SUA (β = 0.020 95% CI 0.008-0.032, P = 0.003). This study showed that SUA was positively correlated with lumbar spine BMD in American men within a certain range. This gives clinicians some insight into how to monitor SUA levels to predict BMD levels during adolescence when bone is urgently needed for growth and development and during old age when bone loss is rapid.

Association between serum uric acid level and bone mineral density in men more than 50 years of age

Background

The results of previous studies on the association between serum uric acid levels and bone mineral density and the risk of osteoporosis are controversial. Fat free mass (FFM) is more strongly associated with bone mineral density (BMD) than it is with body fat mass (BFM). Skeletal muscle mass is assumed to contribute indirectly to the relationship between serum uric acid levels and BMD. Therefore, we aimed to evaluate the association between serum uric acid levels and BMD and abnormal BMD (at least osteopenia) by considering body composition in men aged ≥ 50 years.

Methods

This was a retrospective observational cross-sectional study. We used data obtained from 2,991 men aged ≥50 years who completed questionnaires, anthropometric surveys, laboratory tests, and bone mineral density scans. A subgroup analysis of 1,135 men who additionally underwent body composition data analysis using Inbody® was performed. Multiple linear regression analysis was used to explore the relationship between serum uric acid levels and BMD at three sites (L1-L4, Femur neck, Femur total). In addition, multiple logistic regression analysis was performed to determine the association of serum uric acid levels with abnormal BMD (at least osteopenia).

Results

Positive correlations between serum uric acid levels and BMD at the three sites (L1-L4, Femur neck, Femur total) were observed in unadjusted and fully adjusted models except the BMD of the femoral neck (P-value=0.054).Furthermore, FFM and skeletal muscle mass index (SMI) showed positive association with serum uric acid level and BMD at three sites, with statistical significance. An increase in serum uric acid level was associated with a lower risk of abnormal BMD after adjusting for confounders including FFM and SMI.

Conclusion

Serum uric acid level was positively associated with BMD at three sites and had a protective effect against abnormal BMD after adjusting for multiple confounders, including FFM and SMI, in men aged ≥ 50 years.

Comparison between linear regression and four different machine learning methods in selecting risk factors for osteoporosis in a Chinese female aged cohort

BACKGROUND

Population aging is emerging as an increasingly acute challenge for countries around the world. One particular manifestation of this phenomenon is the impact of osteoporosis on individuals and national health systems. Previous studies of risk factors for osteoporosis were conducted using traditional statistical methods, but more recent efforts have turned to machine learning approaches. Most such efforts, however, treat the target variable (bone mineral density [BMD] or fracture rate) as a categorical one, which provides no quantitative information. The present study uses five different machine learning methods to analyze the risk factors for T-score of BMD, seeking to (1) compare the prediction accuracy between different machine learning methods and traditional multiple linear regression (MLR) and (2) rank the importance of 25 different risk factors.

METHODS

The study sample includes 24 412 women older than 55 years with 25 related variables, applying traditional MLR and five different machine learning methods: classification and regression tree, Naïve Bayes, random forest, stochastic gradient boosting, and eXtreme gradient boosting. The metrics used for model performance comparisons are the symmetric mean absolute percentage error, relative absolute error, root relative squared error, and root mean squared error.

RESULTS

Machine learning approaches outperformed MLR for all four prediction errors. The average importance ranking of each factor generated by the machine learning methods indicates that age is the most important factor determining T-score, followed by estimated glomerular filtration rate (eGFR), body mass index (BMI), uric acid (UA), and education level.

CONCLUSION

In a group of women older than 55 years, we demonstrated that machine learning methods provide superior performance in estimating T-Score, with age being the most important impact factor, followed by eGFR, BMI, UA, and education level.

Association between serum uric acid levels and bone mineral density in patients with osteoporosis: a cross-sectional study

BACKGROUND

The results of studies exploring the association between serum uric acid (SUA) and bone mineral density (BMD) have been controversial and inconsistent. We thus sought to explore whether SUA levels were independently associated with BMD in patients with osteoporosis (OP).

METHODS

This cross-sectional analysis was conducted using prospectively obtained data from the Affiliated Kunshan Hospital of Jiangsu University database pertaining to 1,249 OP patients that were hospitalized from January 2015 - March 2022. BMD was the outcome variable for this study, while baseline SUA levels were the exposure variable. Analyses were adjusted for a range of covariates including age, gender, body mass index (BMI) and a range of other baseline laboratory and clinical findings.

RESULTS

SUA levels and BMD were independently positively associated with one another in OP patients. Following adjustment for age, gender, BMI, blood urae nitrogen (BUN), and 25(OH)D levels, a 0.0286 g/cm² (β, 0.0286; 95% confidence interval [CI], 0.0193-0.0378, P < 0.000001) increase in BMD was observed per 100 μmol/L rise in SUA levels. A non-linear association between SUA and BMD was also observed for patients with a BMI < 24 kg/m², with a SUA level inflection point at 296 μmol/L in the adjusted smoothed curve.

CONCLUSIONS

These analyses revealed SUA levels to be independently positively associated with BMD in OP patients, with an additional non-linear relationship between these two variables being evident for individuals of normal or low body weight. This suggests that SUA levels may exert a protective effect on BMD at concentrations below 296 μmol/L in normal- and low-weight OP patients, whereas SUA levels above this concentration were unrelated to BMD.

Relationship between bone mineral density and hyperuricemia in obesity: A cross-sectional study

BACKGROUND

Obesity is an increasingly severe global public health issue. This study aims to estimate the cross-sectional association between bone mineral density (BMD) and hyperuricemia (HU) in obesity.

METHOD

A total of 275 obese subjects (126 men and 149 women) participated in this cross-sectional study. Obesity was diagnosed as body mass index (BMI) ≥28 kg/m2, whereas HU was defined as the blood uric acid level of 416 μmol/L in men and 360 μmol/L in women. The BMD of the lumbar spine and right hip was measured by dual-energy X-ray absorptiometry (DXA). The multivariable logistic regressions were employed to examine the relationship between BMD and HU in obesity, with the adjustment of gender, age, fasting blood glucose, fasting insulin, homeostasis model assessment of insulin resistance (HOMA-IR), cholesterol, triglycerides, low-density lipoprotein, high-density lipoprotein, creatinine, blood urea nitrogen, high-sensitivity C-reactive protein (hs-CRP), cigarette smoking, and alcohol drinking status.

RESULT

The overall prevalence of HU was 66.9% in this obese population. The mean age and BMI of this population were 27.9 ± 9.9 years and 35.2 ± 5.2 kg/m2, respectively. The multivariable-adjusted OR (the highest vs. lowest BMD quartile) demonstrated a negative relationship between BMD and HU in total (OR = 0.415, 95%CI: 0.182-0.946; p = 0.036), L1 (OR = 0.305, 95%CI: 0.127-0.730; p = 0.008), L2 (OR = 0.405, 95%CI: 0.177-0.925; p = 0.032), and L3 (OR = 0.368, 95%CI: 0.159-0.851; p = 0.020) lumbar vertebrae. In the subgroup analysis for the male population, the BMD was also negatively associated with HU in total (OR = 0.077, 95%CI: 0.014-0.427; p = 0.003), L1 (OR = 0.019, 95%CI: 0.002-0.206; p = 0.001), L2 (OR = 0.161, 95%CI: 0.034-0.767; p = 0.022), L3 (OR = 0.186, 95%CI: 0.041-0.858; p = 0.031), and L4 (OR = 0.231, 95%CI: 0.056-0.948; p = 0.042) lumbar vertebrae. However, such findings did not exist in women. In addition, there was no significant relationship between hip BMD and HU in obesity.

CONCLUSION

Our results showed that the lumbar BMD was negatively associated with HU in obesity. However, such findings only existed in men, rather than women. In addition, no significant relationship between hip BMD and HU existed in obesity. Due to the limited sample size and nature of the cross-sectional design, further large prospective studies are still needed to clarify the issues.

Association between Serum Uric Acid Levels and Bone Mineral Density in Taiwanese Elderly Population

Osteoporosis is a progressive metabolic bone disorder characterised by a decline in bone mineral density (BMD). Some previous studies have reported a controversial relationship between uric acid and osteoporosis. This cross-sectional study aimed to assess the association between serum uric acid levels and BMD in older adults from Taiwan. Data from participants aged ≥ 60 years were collected from 2008 to 2018. Furthermore, the participants were classified based on uric acid level quartiles. Regression models were used to assess the association between uric acid levels and bone health, including BMD values and risk of at least osteopenia. Crude and adjusted models of potential confounders, including age, sex and body mass index (BMI), were used. Compared with the first quartile of uric acid levels, the odds ratios for osteoporosis decreased in the higher uric acid level groups after adjustment for age, sex and BMI. The boxplot analysis showed that BMD values were higher in the groups with higher uric acid levels; moreover, the results of the multivariable linear regression model showed a consistent pattern. Notably, uric acid levels were positively correlated with BMD values. Higher uric acid levels in the elderly population might decrease the risk of at least osteopenia. As opposed to the anti-hyperuricemic policy for younger adults with a relatively lower risk of osteoporosis, BMD evaluation and urate-lowering therapy, goal adjustments should be considered for older adults with lower uric acid levels.

Uric Acid Levels Are Associated with Bone Mineral Density in Mexican Populations: A Longitudinal Study

Background: Inconsistent epidemiological evidence between uric acid (UA) and bone mineral density (BMD) has been observed. Therefore, we evaluated the association between UA and BMD in Mexican adults. Methods: This analysis was conducted on 1423 participants from the Health Workers Cohort Study. We explored cross-sectional associations using linear regression and longitudinal associations using fixed-effects linear regression by sex and age groups (<45 and ≥45 years). Results: In females <45 years old, the cross-sectional analysis showed that UA levels were positively associated with total hip BMD. However, in the longitudinal analysis, we observed a negative association with the femoral neck and lumbar spine BMD. In contrast, in males <45 years old, we found an increase in total hip and femoral neck BMD in the groups with high levels of UA in the longitudinal association. On the other hand, in females ≥45 years old, we observed a longitudinal association between UA and loss of BMD at different sites. We did not observe an association between UA levels and BMD in males ≥45 years old. Conclusions: Our results suggest higher serum UA levels are associated with low BMD at different skeletal sites in Mexican females. Further studies are needed to delineate the underlying mechanisms behind this observation.

Correlation between Vitamin D and Uric Acid in Menopausal Women

Background : Vitamin D deficiency and hyperuricemia are global health problems in post-menopausal women in which parathyroid hormone increases hyperuricemia incidence. Aim : This research purpose to  determine correlation between vitamin D and uric acid levels in postmenopausal women Methods: This research is an observational analytic study with a cross-sectional study design conducted at University of North Sumatra Hospital and Network Hospital in Medan for 12 months on 40 postmenopausal women who met inclusion and exclusion criteria. The data will be analyzed descriptively to determine variables frequency distribution. Previously, normality test of numerical data is carried out. If the data is normally distributed, Pearson correlation test will be carried out, and if the data is not normally distributed, then Spearman correlation test will be used. Results : Mean vitamin D of the sample was 23.11 ng/mL with a standard deviation 4.43 and median value 23.5 ng/mL. while the mean uric acid was 7.52 mg/dL with a standard deviation 0.92 and median value 7.45 mg/dL. There is an inverse relationship between uric acid levels and Vitamin D, as evidenced by Pearson test correlation coefficient of -0.541 with p value = 0.001. Conclusion : There is an inverse correlation between Vitamin D and uric acid levels.