痛风性关节炎合并骨质疏松的危险因素分析OA

Objective To investigate the prevalence of osteoporosis(OP)among patients with gouty arthritis(GA)across different age groups and to identify age-specific risk factors associated with OP,thereby providing evidence for stratified prevention and management of osteoporosis in patients with GA.Methods This retrospective cohort study included 420 patients with GA who attended the General Hospital of Southern Theater Command of the Chinese People's Liberation Army between January 2014 and July 2024.Patients were stratified into three age groups:younger(＜65 years,n=96),middle-aged(65-75 years,n=168),and older(＞75 years,n=156).Demographic characteris-tics,lifestyle factors,comorbidities,biochemical parameters,bone metabolism markers,calcium supplementation,and u-rate-lowering therapy were collected.Variables with P＜0.05 in univariate analysis were entered into multivariable bina-ry logistic regression models to identify independent risk and protective factors for OP in each age group.Receiver operat-ing characteristic(ROC)curve analysis was performed to evaluate the predictive performance of significant factors for oste-oporosis.Results Among the 420 patients with GA,the overall prevalence of OP was 71.43％,and the incidence of fra-gility fractures was 48.10％.Both osteoporosis prevalence and fracture risk were significantly higher in the middle-aged and older groups than in the younger group.Univariate analysis demonstrated that sex,disease duration,alcohol consump-tion,hypertension,low body mass index(BMI),vitamin D deficiency,and abnormal bone turnover markers were associ-ated with OP.Multivariable logistic regression identified vitamin D deficiency as an independent risk factor and regular calcium supplementation as a common protective factor across all age groups,with the protective effect of calcium supple-mentation becoming more pronounced with advancing age.In the younger group,independent risk factors included alcohol consumption,low BMI,urinary pH＜5.5,vitamin D deficiency,and elevated β-C-terminal telopeptide of type Ⅰ col-lagen(β-CTX).In the middle-aged group,female sex,longer disease duration,smoking,alcohol consumption,hy-pertension,elevated triglyceride levels,vitamin D deficiency,and reduced procollagen type ⅠN-terminal propeptide(PINP)were independently associated with OP.In the older group,female sex,longer disease duration,alcohol con-sumption,low BMI,hypocalcemia,urinary pH＜5.5,vitamin D deficiency,and elevated β-CTX were identified as in-dependent risk factors.Blood glucose,most lipid parameters,serum phosphorus,parathyroid hormone,and urate-lower-ing therapy were associated with OP only in univariate analyses and lost significance after adjustment for confounding varia-bles.Conclusion Osteoporosis and fragility fractures are highly prevalent among patients with gouty arthritis,and the as-sociated risk factors exhibit significant age-related heterogeneity.Age-stratified assessment of osteoporosis risk should therefore be incorporated into the clinical management of GA.Routine vitamin D supplementation and calcium administra-tion should be considered for all patients,while individualized preventive strategies based on age-specific risk profiles may further reduce the incidence of osteoporosis and fragility fractures.