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NAFLD and liver fibrosis are not associated with reduced femoral bone mineral density in the general US population

Stefano Ciardullo 1 2Emanuele Muraca 1Francesca Zerbini 1Giuseppina Manzoni 1Gianluca Perseghin 1 2

J Clin Endocrinol Metab. 2021 Apr 20;dgab262.doi: 10.1210/clinem/dgab262. .


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.