Abstract
BackgroundMetabolic bone disorders frequently occur in patients with chronic liver disease; however, the association between liver fibrosis and bone mineral density in patients with non-alcoholic fatty liver disease (NAFLD) is unclear.MethodsThis is a cross-sectional analysis of 231 asymptomatic subjects (160 women, 61.6 years old) from a university hospital setting, between February 2012 and December 2014. Bone mineral density (BMD) was measured at the lumbar spine, femur neck, and total hip using dual-energy X-ray absorptiometry (DXA). Liver fibrosis and steatosis were assessed using transient elastography.ResultsAmong a total of 231 individuals, 129 subjects (55.8%) had NAFLD. BMDs at lumbar spine, femur neck, and total hip were significantly lower in patients having NAFLD with significant fibrosis, compared with patients having NAFLD without significant fibrosis (Ps<0.005). In patients with NAFLD, significant liver fibrosis revealed marked negative correlations with BMD at the lumber spine (r = –0.19, P = 0.032), femur neck (r = –0.19, P = 0.034), and total hip (r = –0.21, P = 0.016). A multivariate linear regression analysis revealed that significant liver fibrosis was independently correlated with low BMD at the femur neck (β = –0.18, P = 0.039) and total hip (β = –0.21, P = 0.005) after adjustment for age, sex, BMI, fasting plasma glucose, alanine aminotransferase, high-density lipoprotein cholesterol, and liver steatosis among patients with NAFLD. Using multivariable logistic regression, significant liver fibrosis was independently associated with overall osteopenia and osteoporosis in subjects having NAFLD (OR = 4.10, 95% CI = 1.02–16.45).ConclusionThe presence of significant liver fibrosis assessed via TE was independently associated with low BMD in NAFLD subjects.
Highlights
Non-alcoholic fatty liver disease (NAFLD), one of the most common chronic metabolic liver disorders, is a major public health problem strongly correlated with growing prevalence of obesity or diabetes [1]
A multivariate linear regression analysis revealed that significant liver fibrosis was independently correlated with low bone mineral density (BMD) at the femur neck (β = –0.18, P = 0.039) and total hip (β = –0.21, P = 0.005) after adjustment for age, sex, Body mass index (BMI), fasting plasma glucose, alanine aminotransferase, high-density lipoprotein cholesterol, and liver steatosis among patients with non-alcoholic fatty liver disease (NAFLD)
Significant liver fibrosis was independently associated with overall osteopenia and osteoporosis in subjects having NAFLD (OR = 4.10, 95% confidence intervals (CIs) = 1.02–16.45)
Summary
Non-alcoholic fatty liver disease (NAFLD), one of the most common chronic metabolic liver disorders, is a major public health problem strongly correlated with growing prevalence of obesity or diabetes [1]. NAFLD ranges from simple steatosis to non-alcoholic steatohepatitis (NASH), representing progressive inflammation, which can progress to liver cirrhosis or hepatocellular carcinoma. Liver fibrosis diagnosed based on liver biopsy rather than NAFLD activity score (NAS), a histological scoring system including features of steatosis, lobular inflammation, and hepatocellular ballooning but not fibrosis, was suggested to be the main crucial prognostic factor for overall and liver-related mortality in subjects with NAFLD [3,4]. Metabolic bone disorders frequently occur in patients with chronic liver disease; the association between liver fibrosis and bone mineral density in patients with non-alcoholic fatty liver disease (NAFLD) is unclear
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