The effect of calcium supplementation on serum urate: analysis of a randomized controlled trial

Gout in Primary Hyperparathyroidism, connecting crystals to the minerals

Musculoskeletal manifestations in primary hyperparathyroidism (PHPT) range from 13% to 93% encompassing pseudogout, vertebral fracture, myopathy, and cord compression. Though pseudogout has been the most prevalent musculoskeletal condition in PHPT, rarely reports of acute gouty attacks in large joints including the knee have been reported in the literature. Here we detail a unique case of PHPT presenting with acute severe bilateral knee joint inflammatory arthritis accompanied by occasional abdominal pain. Joint aspiration fluid study revealed extracellular monosodium urate crystals exhibiting strong negative birefringence on polarized light microscopy suggestive of acute gouty arthritis. Hypercalcemia and hypophosphatemia with high intact parathyroid hormone (iPTH) confirmed the diagnosis of PHPT and a right inferior parathyroid adenoma was localized. Parathyroidectomy resulted in statistically significant clinical improvement of the debilitating joint manifestations, and the patient was able to walk again without support. Although the incidence of gout is increasing because of an overall increase in metabolic syndrome prevalence, a higher prevalence than in the general population is reported in PHPT. Serum uric acid levels positively correlate with serum iPTH levels in PHPT, and parathyroidectomy leads to a reduction in levels. Acute inflammatory joint pain due to urate crystal deposition in a large joint like the knee is an uncommonly reported condition in PHPT. Identifying the correct etiology in such a case can result in marked clinical improvement in the joint manifestations following surgical cure of hyperparathyroidism.

Hyperuricemia: Features of the Diet

The association of hyperuricemia (HU) with cardiovascular disease (CVD), diabetes, metabolic syndrome, and kidney disease has been demonstrated in numerous studies. НU is the main pathogenetic factor in the development of gout and is associated with an increase in overall and cardiovascular mortality. НU is included in the list of factors determining cardiovascular risk. According to epidemiological studies, there is a high prevalence of HU in the world and its increase in recent decades. A number of factors have been identified that contribute to the increased risk of НU. Non-modifiable factors include gender, age, genetic factors, and modifiable factors include diet and lifestyle. Nutritional unbalances, increased life expectancy, increased prevalence of obesity, and increased use of drugs (especially diuretics) are seen as contributing factors to the rise in НU. The review was carried out to summarize the available information on the effect of dietary habits, individual foods and nutrients on serum uric acid (SUA) levels and the risk of developing HU. The review presents the results of scientific studies demonstrating the relationship of НU with the consumption of foods rich in purines (offal, red meat, fish, seafood, legumes), alcohol consumption, drinks sweetened with fructose, coffee, dairy products, vegetables and fruits. Diet correction is an important and necessary step in the prevention and treatment of НU. The article reviews the basic principles of dietary management in HU and provides dietary recommendations for patients. For effective prevention and treatment of НU, a mandatory correction of the diet is required.

Association Between Vitamin D and Hyperuricemia Among Adults in the United States

Background: Serum uric acid can act as a risk factor for cardiovascular disease (CVD) and as antioxidant defense. Vitamin D deficiency can activate the parathyroid to induce the release of parathyroid hormone, which was thought to increase serum uric acid level, and low vitamin D status may also be associated with risk of CVD. No known studies have explored the association between serum 25(OH) D, vitamin D intake, and HU for the American population.

Methods: We extracted 15,723 US adults aged 20–85 years from the National Health and Nutrition Examination Survey (NHANES) in 2007–2014. All dietary intakes were evaluated through 24-h dietary recalls. Multivariable logistic regression analysis was performed to examine the associations after adjustment for confounders.

Results: Compared to the lowest quintile (Q1), for males, adjusted odds ratios (ORs) of HU in Q2 to Q4 of serum 25(OH) D levels were 0.78 (95% CI, 0.65–0.93), 0.97 (0.81–1.16), and 0.72 (0.60–0.88); ORs in Q2–Q5 of total vitamin D intake were 0.83 (0.69–0.98), 0.69 (0.58–0.83), 0.66 (0.55–0.79), and 0.59 (0.48–0.71), respectively. In females, OR was 0.80 (0.66–0.97) of serum 25(OH) D for Q3, and ORs in Q5 of total vitamin D intake were 0.80 (0.65–0.98).

Conclusions: Our findings indicated that the serum 25(OH) D intakes of dietary vitamin D, supplemental vitamin D, and total vitamin D were inversely associated with HU in males. In females, a lower risk of HU with higher serum 25(OH) D, dietary vitamin D, and total vitamin D intake was found, but with no association between supplemental vitamin D intake and the risk of HU.

Female oxidative status in relation to calcium availability, metal pollution and offspring development in a wild passerine

Both Ca deficiency and metal exposure may affect physiological and nutritional condition of breeding females altering their ability to deposit essential resources (e.g. Ca, antioxidants) into the eggs. This effect of the maternal investment into egg quality is not strictly limited to the embryonic period, but may persist after hatching, since nutrient levels in yolks can compromise nestling antioxidant status, growth and fledging success. The goal of this study was to investigate how metal pollution and Ca availability during the breeding season affect oxidative stress biomarkers and plasma biochemistry in adult female pied flycatchers (Ficedula hypoleuca). In addition, we aim to evaluate how maternal antioxidant status and body condition relate to breeding parameters and offspring oxidative balance. Females breeding in a metal-polluted area in SW Finland showed higher metal concentrations compared to the control area, although current levels were below the toxic level able to affect female physiology. In addition, Ca availability was not constraining female oxidative status and general health in the study area. Interestingly, our results suggested that antioxidant response to metals was better when Ca concentrations were high enough to cover the physiological Ca requirements in breeding females. There seems to be a subtle balance between the concentrations of Ca in the organism and the tolerance to metal-related effects that requires further research. This study supports that offspring oxidative balance and nestling development are affected by maternal body condition and antioxidant status.

The Association of Serum Vitamin D Deficiency and Metabolic Risk Factors in Chinese Adults with Prediabetes: A Cross-Sectional Study

The association of serum vitamin D deficiency and metabolic risk factors in Chinese adults with prediabetes (PreDM) has not been investigated. The present study aimed to investigate the association of serum vitamin D deficiency and metabolic risk factors in Chinese adults with PreDM. In this cross-sectional study, we stratified 412 PreDM patients into vitamin D sufficient, vitamin D insufficient and vitamin D deficient subgroups. The physical examination data was collected. Serum 25-hydroxyvitamin D₃ [25(OH)D₃] were measured by high performance liquid chromatography. The prevalence of vitamin D deficiency and insufficiency in PreDM patients were 30.58% and 26.70%, respectively. Compared with the vitamin D deficient group, the prevalence of metabolic syndrome, central obesity, hyperglycemia and hypertension were higher than those in the vitamin D insufficient or sufficient group (p<0.05). Moreover, the prevalence of dyslipidemia in the vitamin D deficient group was higher than those in the vitamin D sufficient group (p<0.05). We observed an inverse relationship between 25(OH)D₃ levels and waist circumference, triglyceride, and serum uric acid (β=-0.315; β=-0.134; β=-0.239), a positive relationship between 25(OH)D₃ levels and high-density lipoprotein cholesterol (β=0.197) after adjusting for age, sex and body mass index. Vitamin D deficiency is very common among PreDM patients in China and this deficiency is related to metabolic risk factors.

Uric Acid-Induced Inflammation Is Mediated by the Parathyroid Hormone:25-Hydroxyvitamin D Ratio in Obese Adolescents

BACKGROUND

Elevated serum uric acid (SUA) level is strongly associated with prevalence of metabolic syndrome (MS), elevated parathyroid hormone (PTH) levels, and 25-hydroxyvitamin D [25(OH)D] insufficiency in adults. We examined the relationship among SUA, [25(OH)D], PTH, and inflammation in obese adolescents, in obese adolescents with and without MS.

METHODS

Body mass index, body composition, 25(OH)D, PTH, fasting lipids, glucose, high-sensitivity C-reactive protein (hs-CRP), SUA, hemoglobin A1c (HbA1c), insulin, and the homeostatic model assessment of insulin resistance (HOMA-IR) were evaluated in 152 obese adolescents.

RESULTS

Hyperuricemia [SUA ≥ 6.0 mg/dL (357 μM)] was present in 54.6% of entire cohort without significant ethnic/racial differences. While SUA was negatively correlated with high-density lipoprotein cholesterol (HDL-C) and 25(OH)D (P < 0.01), it was positively correlated with fat mass (FM), PTH, PTH:25(OH)D, and hs-CRP (P < 0.01). Vitamin D deficiency [25(OH)D <50 nM] was present in 47.4% of subjects, and PTH and 25(OH)D were inversely correlated (P < 0.0001). FM was negatively correlated with 25(OH)D (r = -0.29; P < 0.001), but was positively correlated with PTH (P < 0.0001). MS was identified in 53.3% of cohort with higher FM, SUA, hs-CRP, HOMA-IR, PTH, and PTH:25(OH)D ratio than the non-MS subgroup (P < 0.001) with similar 25(OH)D status. Multiple regression analysis showed that the PTH:25(OH)D ratio mediated the relationship between SUA and hs-CRP (β = 0.19, P < 0.05 to β = 0.15, P = 0.19).

CONCLUSIONS

Hyperuricemia is strongly associated with PTH and hs-CRP levels independent of vitamin D status. The relationship between SUA and low-grade inflammation is mediated by the PTH:25(OH)D ratio in obese adolescents.

Potential causal associations between vitamin D and uric acid: Bidirectional mediation analysis

Vitamin D deficiency, a major public-health worldwide, is associated with hyperuricemia but casual association is questioned. The study was conducted to determine potential causal associations between 25-hydroxy vitamin D (25(OH)D) and uric acid (UA). A cross-sectional study of the Electricity Generating Authority of Thailand (EGAT3) cohort was conducted. Subjects (n = 2,288) were used to genotype the group-specific component (GC) at rs2282679 and ATP-binding cassette subfamily G member 2 (ABCG2) at rs2231142. Mediation analysis with 1000-replication bootstrap was applied to construct causal pathways i.e., rs2282679 → 25(OH)D → UA and rs2231142 → UA → 25(OH)D: The mediator (i.e., 25(OH)D and UA) was firstly regressed on the studied gene (i.e., rs2282679 and rs2231142). A potential causal effect of C allele on UA through 25(OH)D was -0.0236 (95% CI: -0.0411, -0.0058), indicating every minor C allele resulted in decreasing the 25(OH)D and then significantly decreased the UA by 0.0236 unit. For the second pathway, the mediation effect was 0.0806 (95% CI: 0.0107, 0.1628); every T allele copy for rs2231142 increased UA and thus increased 25(OH)D by 0.0806 unit. Our study suggested potential causal associations between the GC gene and UA through the 25(OH)D mediator, and the ABCG2 and the 25(OH)D through the UA mediator but the absolute effects are very clinically small.

Low levels of serum uric Acid increase the risk of low bone mineral density in young male patients with ankylosing spondylitis

OBJECTIVE

Uric acid (UA) has antiosteoporotic effects in postmenopausal women. This study investigated the association between serum UA levels and bone mineral density (BMD) in young male patients with ankylosing spondylitis (AS).

METHODS

One hundred fifty patients who fulfilled the modified New York criteria for the classification of AS were analyzed. All patients were male and under 50 years of age. BMD, serum UA concentrations, clinical variables, and radiographic progression were assessed. The associations between UA and BMD at the lumbar spine and hip were evaluated using multiple linear regression analysis. Multivariate logistic regression analyses were performed to identify risk factors associated with low BMD.

RESULTS

Mean serum UA concentration in the 150 patients with AS was 5.5 ± 1.3 mg/dl. BMD at the lumbar spine, but not at the total hip and femoral neck, increased with increasing serum UA tertiles (p = 0.033). The significant positive association between serum UA and BMD at the lumbar spine remained after adjustment for confounding factors (β = 0.185, p = 0.014, adjusted R(2) = 0.310). Multiple logistic regression analyses showed that lower UA concentrations (OR 4.02, 95% CI 1.34-12.3) and body mass index and increased erythrocyte sedimentation rate were independently associated with the risk of low BMD.

CONCLUSION

Lower serum UA levels are associated with lower BMD in young male patients with AS. UA may be a novel predictive marker or therapeutic target in patients with AS.

Vitamin D deficiency associates with γ-tocopherol and quadriceps weakness but not inflammatory cytokines in subjects with knee osteoarthritis

Knee osteoarthritis (OA) is a degenerative joint condition and a leading cause of physical disability in the United States. Quadriceps weakness and inflammatory cytokines contribute to the pathogenesis of knee OA, and both of which, increase with vitamin D deficiency. Other micronutrients, such as vitamins C and E and β-carotene, modulate inflammatory cytokines and decrease during inflammation. The purpose of this study was to test the hypothesis that vitamin D deficiency associates with quadriceps weakness, an increase in serum cytokines, and a decrease in circulating micronutrients in subjects with knee OA. Subjects (age, 48±1 y; serum 25(OH)D, 25.8±1.1 ng/mL) with knee OA were categorized as vitamin D deficient (n=17; serum 25(OH)D≤20 ng/mL), insufficient (n=21; serum 25(OH)D 20–29 ng/mL), or sufficient (n=18; serum 25(OH)D≥30 ng/mL). Single-leg strength (concentric knee extension–flexion contraction cycles at 60 °/s) and blood cytokine, carotene (α and β), ascorbic acid, and tocopherol (α and γ) concentrations were measured. Quadriceps peak torque, average power, total work, and deceleration were significantly (all p<0.05) impaired with vitamin D deficiency. Serum γ-tocopherol concentrations were significantly (p<0.05) increased with vitamin D deficiency. In the vitamin D sufficient group, γ-tocopherol inversely correlated (r=−0.47, p<0.05) with TNF-α, suggesting a pro-inflammatory increase with a γ-tocopherol decrease despite a sufficient serum 25(OH)D concentration. We conclude that vitamin D deficiency is detrimental to quadriceps function, and in subjects with vitamin D sufficiency, γ-tocopherol could have an important anti-inflammatory role in a pathophysiological condition mediated by inflammation.

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We investigated the vitamin D association with mediators of knee osteoarthritis.

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Vitamin D deficiency associated with quadriceps dysfunction.

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Vitamin D deficiency was not associated with serum cytokines.

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Vitamin D deficiency associated with increased plasma γ-tocopherol concentrations.

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γ-Tocopherol inversely correlated with TNF-α in vitamin D sufficient subjects.

Association between vitamin D insufficiency and elevated serum uric acid among middle-aged and elderly Chinese Han women

BACKGROUND

Association between vitamin D insufficiency and hyperuricemia has not been reported so far. We aimed to study the association of vitamin D insufficiency with elevated serum uric acid among middle-aged and elderly Chinese Han women.

METHODS

We collected data from participants residing in Jinchang district of Suzhou from January to May, 2010. Serum uric acid, 25-hydroxy vitamin D and other traditional biomarkers including fasting plasma glucose and blood lipids were determined in 1726 women aged above 30 years. Association between vitamin D insufficiency and elevated uric acid was analyzed in premenopausal and postmenopausal women, respectively.

RESULTS

Among postmenopausal women, 25-hydroxy vitamin D level of participants with elevated uric acid was lower than that of those with normal uric acid (median [interquartile range]: 35[28-57] vs 40[32-58], µg/L; P = 0.006). Elevated uric acid was more prevalent in participants with vitamin D insufficiency compared to those without vitamin D insufficiency (16.50% vs 8.08%; P<0.001). Association between vitamin D insufficiency and elevated uric acid was not significant among premenopausal women. However, participants with vitamin D insufficiency were more likely to have elevated uric acid compared with those without vitamin D insufficiency among postmenopausal women (OR, 95% CI: 2.38, 1.47-3.87). Moreover, after excluding individuals with diabetes and/or hypertension, the association of vitamin D insufficiency with elevated uric acid was still significant (OR, 95% CI: 2.48, 1.17-5.44).

CONCLUSIONS

Vitamin D insufficiency was significantly associated with elevated uric acid among postmenopausal Chinese Han women. This study suggested that a clinical trial should be conducted to confirm the association of vitamin D insufficiency with hyperuricemia.

Serum uric acid concentrations in meat eaters, fish eaters, vegetarians and vegans: a cross-sectional analysis in the EPIC-Oxford cohort

INTRODUCTION

Circulating concentrations of uric acid may be affected by dietary components such as meat, fish and dairy products, but only a few studies have compared uric acid concentrations among individuals who exclude some or all of these foods from their diet. The aim of this study was to investigate differences in serum uric acid concentrations between meat eaters, fish eaters, vegetarians and vegans.

SUBJECTS AND METHODS

A sample of 670 men and 1,023 women (424 meat eaters, 425 fish eaters, 422 vegetarians and 422 vegans, matched on age and sex) from the European Prospective Investigation into Cancer and Nutrition Oxford cohort were included in this cross-sectional analysis. Diet was assessed using a semi-quantitative food frequency questionnaire and serum concentrations of uric acid were measured. Mean concentrations of uric acid by diet group were calculated after adjusting for age, body mass index, calcium and alcohol intake.

RESULTS

In both men and women, serum uric acid concentrations differed significantly by diet group (p<0.0001 and p = 0.01, respectively). The differences between diet groups were most pronounced in men; vegans had the highest concentration (340, 95% confidence interval 329-351 µmol/l), followed by meat eaters (315, 306-324 µmol/l), fish eaters (309, 300-318 µmol/l) and vegetarians (303, 294-312 µmol/l). In women, serum uric acid concentrations were slightly higher in vegans (241, 234-247 µmol/l) than in meat eaters (237, 231-242 µmol/l) and lower in vegetarians (230, 224-236 µmol/l) and fish eaters (227, 221-233 µmol/l).

CONCLUSION

Individuals consuming a vegan diet had the highest serum concentrations of uric acid compared to meat eaters, fish eaters and vegetarians, especially in men. Vegetarians and individuals who eat fish but not meat had the lowest concentrations of serum uric acid.

Characterization of new bone formation in gout: a quantitative site-by-site analysis using plain radiography and computed tomography

INTRODUCTION

Radiographic descriptions of gout have noted the tendency to hypertrophic bone changes. The aim of this study was to characterize the features of new bone formation (NBF) in gout, and to determine the relationship between NBF and other radiographic features of disease, particularly erosion and tophus.

METHODS

Paired plain radiographs (XR) and computed tomography (CT) scans of 798 individual hand and wrist joints from 20 patients with gout were analyzed. Following a structured review of a separate set of images, films were scored for the presence of the following features of NBF: spur, osteophyte, periosteal NBF, ankylosis and sclerosis. The relationship between NBF and other radiographic features was analyzed.

RESULTS

The most frequent forms of NBF were bone sclerosis and osteophyte. Spur and periosteal NBF were less common, and ankylosis was rare. On both XR and CT, joints with bone erosion were more likely to have NBF; for CT, if erosion was present, the odds ratios (OR) was 45.1 for spur, 3.3 for osteophyte, 16.6 for periosteal NBF, 26.6 for ankylosis and 32.3 for sclerosis, P for all < 0.01. Similarly, on CT, joints with intraosseous tophus were more likely to have NBF; if tophus was present, the OR was 48.4 for spur, 3.3 for osteophyte, 14.5 for periosteal NBF, 35.1 for ankylosis and 39.1 for sclerosis; P for all < 0.001.

CONCLUSIONS

This detailed quantitative analysis has demonstrated that NBF occurs more frequently in joints affected by other features of gout. This work suggests a connection between bone loss, tophus, and formation of new bone during the process of joint remodelling in gout.

The association of dietary intake of purine-rich vegetables, sugar-sweetened beverages and dairy with plasma urate, in a cross-sectional study

Introduction

Hyperuricemia is a strong risk factor for gout. The incidence of gout and hyperuricemia has increased recently, which is thought to be, in part, due to changes in diet and lifestyle. Objective of this study was to investigate the association between plasma urate concentration and: a) food items: dairy, sugar-sweetened beverages (SSB) and purine-rich vegetables; b) related nutrients: lactose, calcium and fructose.

Methods

A total of 2,076 healthy participants (44% female) from a population-based case-control study in Scotland (1999–2006) were included in this study. Dietary data was collected using a semi-quantitative food frequency questionnaire (FFQ). Nutrient intake was calculated using FFQ and composition of foods information. Urate concentration was measured in plasma.

Results

Mean urate concentration was 283.8±72.1 mmol/dL (females: 260.1±68.9 mmol/dL and males: 302.3±69.2 mmol/dL). Using multivariate regression analysis we found that dairy, calcium and lactose intakes were inversely associated with urate (p = 0.008, p = 0.003, p = 0.0007, respectively). Overall SSB consumption was positively associated with urate (p = 0.008), however, energy-adjusted fructose intake was not associated with urate (p = 0.66). The intake of purine-rich vegetables was not associated to plasma urate (p = 0.38).

Conclusions

Our results suggest that limiting purine-rich vegetables intake for lowering plasma urate may be ineffectual, despite current recommendations. Although a positive association between plasma urate and SSB consumption was found, there was no association with fructose intake, suggesting that fructose is not the causal agent underlying the SSB-urate association. The abundant evidence supporting the inverse association between plasma urate concentration and dairy consumption should be reflected in dietary guidelines for hyperuricemic individuals and gout patients. Further research is needed to establish which nutrients and food products influence plasma urate concentration, to inform the development of evidence-based dietary guidelines.

The independent association between parathyroid hormone levels and hyperuricemia: a national population study

Introduction

Increased frequencies of hyperuricemia and gout have been associated with primary hyperparathyroidism, and recent clinical trials of parathyroid hormone (PTH) have reported hyperuricemic adverse events. We evaluated the potential population impact of PTH on serum uric acid (SUA) levels by using a nationally representative sample of United States adults.

Methods

By using data from 8,316 participants aged 18 years and older in the National Health and Nutrition Examination Survey 2003 to 2006, we examined the relation between serum PTH and SUA levels with weighted linear regression. Additionally, we examined the relation with hyperuricemia by using weighted logistic regression.

Results

SUA levels increased with increasing serum PTH concentration. After adjusting for age, sex, dietary factors, glomerular filtration rate (GFR), and other potentially related biomarkers (calcium, phosphorus, alkaline-phosphatase, 25-hydroxyvitamin D), the SUA level differences from the bottom (referent) to top quintiles of serum PTH levels were 0, 8, 13, 14, and 19 μM (95% CI, 12 to 26; P for trend, < 0.001). These estimates were larger among renally impaired individuals (multivariate SUA difference between the extreme quintiles of PTH, 26 versus 15 μM among those with GFR ≥ 60 versus < 60 ml/min per 1.73 m², respectively) (P for interaction = 0.004). The odds of hyperuricemia by various definitions increased with increasing PTH levels as well (multivariate P values for trend, < 0.05).

Conclusions

These nationally representative data indicate that serum PTH levels are independently associated with serum uric acid levels and the frequency of hyperuricemia at the population level.

Effects of dairy intake on hyperuricemia and gout

Dietary modification is frequently recommended for patients with gout. Longitudinal observational studies have shown a clear inverse relationship between low-fat dairy intake and gout risk. Several checkpoints in gout pathogenesis may be targeted by dairy intake. Cross-sectional and short-term intervention studies of healthy volunteers have demonstrated that low-fat dairy intake has a moderate urate-lowering effect. In addition, certain dairy fractions, particularly glyco-macropeptide and G600 milk fat extract, have anti-inflammatory properties in experimental models of acute gout. Such anti-inflammatory properties may contribute to the reduction in gout risk through inhibition of the inflammatory response to monosodium urate crystals within the joint. Well-controlled intervention studies in patients with gout are now needed to determine the clinical relevance of these observations in order to guide dietary recommendations for this disease.

Serum uric acid is associated with bone health in older men: a cross-sectional population-based study

Serum uric acid (UA) is a strong endogenous antioxidant. Since oxidative stress has been linked to osteoporosis, we examined the association between serum UA levels and bone mineral density (BMD), prevalent vertebral and nonvertebral fractures, and laboratory measures such as calcitropic hormones and bone turnover marker levels. This cross-sectional analysis consisted of 1705 community-dwelling men aged 70 years or over who participated in the baseline part of the Concord Health and Ageing in Men Project (CHAMP), a population-based study of older men in Sydney, Australia. BMD at all sites was significantly higher among men with serum UA levels above the group median than among men with UA levels below the median. In multiple regression analyses adjusted for potential confounders, serum UA remained associated with BMD at all sites (β = 0.12 to 0.14, p < .001), serum calcium (β = 0.11, p = .001), parathyroid hormone (β = 0.09, p = .002), 25-hydroxyvitamin D (β = 0.09, p = .005), and was negatively associated with urinary excretion amino-terminal cross-linked telopeptide of type 1 collagen (β = -0.09, p = .006). Overall, serum UA accounted for 1.0% to 1.44% of the variances in BMD (R(2)  = 0.10 to 0.22). In multiple logistic regression analyses, above-median serum UA levels were associated with a lower prevalence of osteoporosis at the femoral neck [odds ratio (OR) = 0.42, 95% confidence interval (CI) 0.22-0.81, p = .010) and lumbar spine (OR = 0.44, 95% CI 0.23-0.86, p = .016) and a lower prevalence of vertebral (OR = 0.62, 95% CI 0.43-0.91, p = .015) and nonvertebral (OR = 0.51, 95% CI 0.29-0.89, p = .018) fractures. In conclusion, higher serum UA levels are associated with higher BMD at all skeletal sites and with a lower prevalence of vertebral and nonvertebral fractures in older men.