Abstract
Context
It is still debated whether nonalcoholic fatty liver disease (NAFLD) may be a risk factor for reduced bone mineral density (BMD), and it is not known whether liver fibrosis, which is the major predictor of future development of liver-related events in patients with NAFLD, has an influence on BMD.
Objective
To assess whether liver steatosis and fibrosis are associated with reduced BMD in the general US population.
Design
Cross-sectional analysis of the population-based 2017-2018 cycle of the National Health and Nutrition Examination Survey (NHANES), in which vibration controlled transient elastography (VCTE) and dual-energy x-ray absorptiometry (DXA) of the femoral neck were simultaneously available. Controlled attenuation parameter (CAP) ≥ 274 dB/m was considered indicative of liver steatosis, while a median liver stiffness measurement (LSM) ≥ 8 kPa indicated the presence of significant liver fibrosis.
Patients
We included all participants older than 50 with reliable VCTE and femoral neck DXA results (925 men and 859 women).
Main Outcomes
Femoral neck BMD values indicative of osteopenia or osteoporosis.
Results
Steatosis and significant fibrosis were highly prevalent in the studied population, being present in 53.1% and 9.6%of men and 44.2% and 8.0% of women, respectively. In univariate analysis, liver steatosis was associated with a lower prevalence of osteoporosis in both men and women, while no difference was noted according to the degree of liver fibrosis. After adjustment for potential confounders including age, BMI, race-ethnicity, cigarette smoke and diabetes, neither CAP, nor LSM were significantly associated with reduced BMD in both sexes.
Conclusions
Liver steatosis and fibrosis are not associated with femoral DXA-based diagnosis of osteopenia or osteoporosis in the US population older than 50 years.
Significant Liver Fibrosis Assessed Using Transient Elastography is Independently Associated with Low Bone Mineral Density