Lumbar Bone Mineral Density Negatively Linked to Hyperuricemia in Obesity

The lumbar bone mineral density (BMD) was negatively associated with hyperuricemia in obese male patients, according to a study published in Frontiers in Endocrinology.¹ However, no significant link between hyperuricemia and hip BMD was reported in this patient population. Investigators encourage performing larger prospective studies to further explain the issues.

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As more than half of Chinese adults are classified as either overweight or obese, obesity is an increasingly severe public health issue. Further, obesity may be linked to a higher risk of hyperuricemia, the precursor of gout.²

“As far as we know, a large number of studies have examined the association between hyperuricemia and BMD. However, no final conclusion can be obtained,” wrote a team of Chinese investigators. “The potential reasons for such discrepancy may be attributed to the variety of population characteristics, including genetic background, age, body fat proportion or confounders adjusted, and different lifestyle factors. Therefore, it is significant and necessary to consider the issue in different sub-populations.”

The cross-sectional study enrolled 275 obese participants (126 males and 149 females), defined as a body mass index (BMI) of ≥28 kg/m². Hyperuricemia was defined as a blood uric acid level of 416 μmol/L in male subjects and 360 μmol/L in female subjects. Dual-energy X-ray absorptiometry (DXA) measured the BMD of the lumbar spine and right hip.

Multivariable logistic regressions were used to determine any relationship between BMD and hyperuricemia in obesity, while adjusting for age, sex, fasting blood glucose, fasting insulin, homeostasis model assessment of insulin resistance (HOMA-IR), high- and low-density lipoprotein, smoking status, alcohol consumption, high-sensitivity C-reactive protein (hs-CRP), cholesterol, and triglycerides.

The mean age of the study population waws 27.9 years and the mean BMI was 35.2 kg/m². In obese participants, the overall prevalence of hyperuricemia was 66.9%. A negative relationship between BMD and hyperuricemia in total was demonstrated in the multivariable-adjusted odds ratio (OR = .415, 95% confidence interval [CI]: .182 – .946; P = .036). Similarly, this relationship was shown in the L1 (OR = .305, 95% CI: .127 – .730; P = .008), L2 (OR = .405, 95% CI: .177 – .925; P = .032), and L3 (OR = .368, 95% CI: .159 – .85; P = .020) lumbar vertebrae.

According to the subgroup analysis for the male participants, the BMD was also negatively linked to hyperuricemia in total (OR = .077, 95% CI: .014 – .427; P = .003), as well as L1 (OR = .019, 95% CI: .002 – .206; P = .001), L2 (OR = .161, 95% CI: .034 – .767; P = .022), L3 (OR = .186, 95% CI: .041 – .858; P = .031), and L4 (OR = .231, 95% CI: .056 – .948; P = .042) lumbar vertebrae. However, these results were not mirrored in female participants.

A significant relationship between hip BMD and hyperuricemia was not demonstrated in multivariable-adjusted OR regarding the total hip (OR = .996, 95% CI: .365 – 2.718; P = .994), trochanter (OR = .986, 95% CI: .375 – 2.590; P = .976), femoral neck (OR = 1.086, 95% CI: .377 – 3.129; P = .879), and Ward’s triangle (OR = 1.965, 95% CI: .695 – 5.556; P = .203).

Investigators emphasized several strengths of the study, including being the first to evaluate the association between hyperuricemia and BMD as well as determining this relationship using different bone locations. However, they noted that the cross-sectional study design prevents causal relationship assessment. Additionally, results may be susceptible to possible recall bias due to the surveys that were used to collect certain clinical data.

References

1. ^{Zhang Y, Tan M, Liu B, et al. Relationship between bone mineral density and hyperuricemia in obesity: A cross-sectional study. Front Endocrinol (Lausanne). 2023;14:1108475. Published 2023 Mar 28. doi:10.3389/fendo.2023.1108475}
2. ^{Zhang Y, Yang T, Zeng C, Wei J, Li H, Xiong Y-L, et al. Is coffee consumption associated with a lower risk of hyperuricaemia or gout? a systematic review and meta-analysis. BMJ Open (2016) 6(7):e009809. doi: 10.1136/bmjopen-2015-009809}