Association of nonalcoholic fatty liver disease with low bone mass in postmenopausal women

Abstract

Osteoporosis is a disease associated with insulin resistant states such as central obesity, diabetes, and metabolic syndrome. Non-alcoholic fatty liver disease (NAFLD) is also increased in such conditions. However, little is known about whether osteoporosis and nonalcoholic fatty liver disease are etiologically related to each other or not. We examined whether bone mineral density (BMD) is associated with NAFLD in pre- and postmenopausal women. Four hundred eighty-one female subjects (216 premenopausal and 265 postmenopausal) were enrolled. Lumbar BMD was measured using dual-energy X-ray absorptiometry. Liver ultrasonography was done to check the severity of fatty liver. We excluded subjects with a secondary cause of liver disease. Blood pressure, lipid profile, fasting plasma glucose, alanine aminotransferase (ALT), aspartate aminotransferase, and body mass index were measured in every subject. Mean lumbar BMD was lower in subjects with NAFLD than those without NAFLD in postmenopausal women (0.98 ± 0.01 vs. 1.01 ± 0.02 g/cm², P = 0.046). Multiple correlation analysis revealed a significant association between mean lumbar BMD and NAFLD in postmenopausal subjects after adjusting for age, body mass index, ALT, smoking status, and alcohol consumption (β coefficient -0.066, 95% CI -0.105 to -0.027, P = 0.001). Even after adjusting the presence of metabolic syndrome, the significance was maintained (β coefficient -0.043, 95% CI -0.082 to -0.004, P = 0.031). Lumbar BMD is related with NAFLD in postmenopausal females. We suggest that postmenopausal women with NAFLD may have a higher risk of osteoporosis than those without.

Ectopic and Serum Lipid Levels Are Positively Associated with Bone Marrow Fat in Obesity

“…Lipids and lipoproteins are emerging as important regulators of skeletal physiologic characteristics and have been shown to inhibit osteoblast and to enhance osteoclast differentiation and survival (7,8). Findings in a recent study (9) in postmenopausal women have revealed decreased BMD in subjects with nonalcoholic fatty liver disease, which is common in patients with the metabolic syndrome and obesity, suggesting an etiologic relationship between liver fat and bone loss. Intramyocellular lipids (IMCL) are ectopic lipids deposited in skeletal muscle that are increased in obesity and type 2 diabetes mellitus, and accumulation of IMCL is implicated as an etiologic factor in the development of muscle insulin resistance (10).…”

“…IMCL are increased in subjects with obesity and are thought to play an etiologic role in the development of insulin resistance (10). However, IMCL can also be increased between IHL and BMD in postmenopausal women with nonalcoholic fatty liver disease (9). Potential mechanisms for low BMD in patients with chronic liver disease include decreased levels of insulin-like growth factor 1 (25) and detrimental effects of bilirubin level on osteoblast proliferation (26).…”

Bone Mineral Density Assessment in Chronic Liver Disease

“…Among the cirrhotic patients increased prevalence of osteopenia and osteoporosis has been demonstrated in patients with chronic liver disease of different etiologies in the recent times [3]. Osteoporosis is the only complication that persists for years after liver transplantation [4].…”

Alcoholic liver disease and changes in bone mineral density

“…BMD loss and the consequent increase in fracture risk have been described mainly in chronic cholestatic diseases -primary biliary cirrhosis (PBC) and primary sclerosing cholangitis-and in advanced stages of liver cirrhosis (3). However, an increasing number of observations have been published in recent years on the topic of BMD alterations in the context of liver diseases of other aetiologies and in the non-cirrhotic stage, such as viral hepatitis (4), non-alcoholic fatty liver disease (5), alcoholic liver disease (6) (ALD) and haemochromatosis (7,8).…”