Abstract
ObjectiveNonalcoholic fatty liver disease (NAFLD) and sarcopenia, which are common in elderly men, are known as risk factors of fracture. However, few studies have examined the association with fracture in these patients. Therefore, we aimed to investigate the association between NAFLD with or without sarcopenia and 10-year fracture probability in Korean men aged ≥50 years.Materials and MethodsData of 2,525 individuals from the 2010–2011 Korea National Health and Nutrition Examination Survey were analyzed. NAFLD was defined using the fatty liver index (FLI) and comprehensive NAFLD score (CNS), and liver fibrosis using the fibrosis 4 calculator. Sarcopenia was defined as the lowest quintile for sex-specific sarcopenia index cutoff; values. The Fracture Risk Assessment (FRAX) tool was used to predict the 10-year probability of major osteoporotic and hip fractures.ResultsCompared to the no NAFLD group, the 10-year major osteoporotic fracture probability was significantly associated with the FLI-defined (β = 0.16, P = 0.002) and CNS-defined (β = 0.20, P < 0.001) NAFLD groups with liver fibrosis. Similarly, the 10-year hip fracture probability was significantly associated with the FLI- and CNS-defined NAFLD with liver fibrosis groups compared to the group without NAFLD (FLI-defined group, β = 0.04, P = 0.046; CNS-defined group, β = 0.05, P = 0.048). Furthermore, in the group with sarcopenia, the 10-year major osteoporotic fracture probability was significantly associated with the FLI- and CNS-defined NAFLD with liver fibrosis groups compared to the group without NAFLD (FLI-defined group, β = 0.29, P = 0.003; CNS-defined group, β = 0.38, P < 0.001).ConclusionsNAFLD with liver fibrosis is significantly associated with a higher 10-year major osteoporotic and hip fracture probability in Korean men aged ≥50 years, and this positive association was more profound in patients with sarcopenia. Therefore, screening middle-aged to elderly men who have NAFLD combined with liver fibrosis and sarcopenia may help prevent fractures.
Highlights
Fractures reduce the quality of life, and increase medical and health care cost, thereby imposing a significant financial and socioeconomic burden [1]
From the remaining 2,724 patients, those with missing data on factors needed for calculating the fatty liver index (FLI), comprehensive Nonalcoholic fatty liver disease (NAFLD) score (CNS), fibrosis 4 calculator (FIB-4), and FRAX were further excluded
In the analysis of the three groups of NAFLD defined by FLI and CNS, age was the youngest and the 10-year hip fracture probability was the lowest in the NAFLD without liver fibrosis group (P < 0.001 and P = 0.001, respectively)
Summary
Fractures reduce the quality of life, and increase medical and health care cost, thereby imposing a significant financial and socioeconomic burden [1]. It is important to predict and prevent fractures. The Fracture Risk Assessment (FRAX), which is a country-specific instrument developed by the World Health Organization (WHO), is the most widely used fracture prediction tool for individuals aged > 40 years [2]. Based on FRAX, 37.7% of menopausal women and 12.7% of men aged over 50 years in South Korea are at high risk of osteoporotic fracture [3]. Another study found that South Korean women and men have an average of 59.5% and 23.8% risk of osteoporotic fractures, respectively, in their lifetime [4]
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