Association of Serum Uric Acid Level With Bone Mineral Density and the Risk of Osteoporosis: A Dose-Response Meta-Analysis

Objective: Serum uric acid (SUA) may play positive roles in diseases associated with oxidative stress, such as osteoporosis (OP). Nevertheless, the specific impact of SUA levels on both bone mineral density (BMD) and the risk of OP remains uncertain. Considering such information crucial for clinicians when making decisions about urate-lowering therapy (ULT), we sought to fill this gap by conducting dose-response meta-analyses.

Methods: PubMed, EMBASE, and Cochrane Library were searched for studies that met the inclusion criteria. Pooled standardized mean difference (SMD) for BMDs and the odds ratio (OR) for OP between the highest and lowest SUA categories as well as the nonlinear dose-response relationships were estimated.

Results: Pooled SMDs indicate that participants in the highest category of SUA have greater BMDs at the lumbar spine (SMD = 0.37; 95% CI: 0.27, 0.46), femoral neck (SMD = 0.25; 95% CI: 0.21, 0.29), total hip (SMD = 0.34; 95% CI: 0.26, 0.42), and lower risk of OP (OR = 0.59, 95% CI: 0.52, 0.67) compared with the lowest. The nonlinear dose-response relationships were also observed. However, when the SUA level exceeded 6 mg/dL, the dose-response curve between SUA levels and the risk of OP tended to be flattened.

Conclusion: Nonlinear dose-response relationships were found that higher SUA levels are associated with greater BMDs and lower risk of OP. For patients receiving ULT, maintaining SUA level at around 6 mg/dL may be appropriate from the perspective of bone metabolism.