Association of Nonalcoholic Fatty Liver Disease With Osteoporotic Fractures: A Cross-Sectional Retrospective Study of Chinese Individuals

Abstract

Objective: Nonalcoholic fatty liver disease (NAFLD) is related to several inflammatory or metabolic diseases. However, findings of previous studies investigating the association between NAFLD and BMD are inconsistent. Only one study reported a potential association between NAFLD and osteoporotic fracture. This study investigated whether NAFLD in older participants (>55 years) was associated with osteoporotic fracture risk.Materials and Methods: This cross-sectional, observational study included 2,695 participants (35.7% men, 614 cases of NAFLD, and 383 fractures). Standardized questionnaires, laboratory tests, and physical and ultrasonic examinations were completed.Results: After adjusting for various factors including serum triglycerides (TG), high-density cholesterol (HDL-C), and low-density lipoprotein cholesterol (LDL-C), multivariate logistic regression models revealed a marginal association between NAFLD and osteoporotic fracture risk in men (odds ratio [OR], 1.86; 95% confidence interval [CI], 1.06–3.27; P = 0.030) but no association in women (OR, 1.05; 95% CI, 0.74–1.48; P = 0.800). Further stratified analyses showed a significant association between NAFLD and osteoporotic fracture risk in men without high TG, low HDL-C, and high LDL-C.Conclusions: There was a significant association between NAFLD and osteoporotic fracture risk in older Chinese men, particularly men without dyslipidemia.

Systematic review with meta‐analysis: non‐alcoholic fatty liver disease is associated with a history of osteoporotic fractures but not with low bone mineral density

“…Moreover, it remains uncertain whether an association also exists between low BMD and severity of NAFLD. Recently, some large cross‐sectional studies of Chinese middle‐aged and elderly individuals also showed that ultrasound‐diagnosed NAFLD was significantly associated with a self‐reported history of osteoporotic fractures in older men, but not in women . Similar to observations in patients with obesity or type 2 diabetes, these latter findings raise the possibility that BMD might underestimate the long‐term risk of osteoporotic fractures in individuals with NAFLD (who are often obese or have diabetes).…”

“…Figure summarises the results of the literature search and study selection. After excluding duplicates, based on titles and abstracts of 148 citations (in accordance with the aforementioned exclusion criteria of the meta‐analysis), we initially identified 17 potentially relevant studies from PubMed, Web of Science, and Scopus databases prior to 31 August 2018 (last date searched). After examining the full text of these 17 publications, we further excluded five studies, because of unsatisfactory inclusion criteria (ie, use of fatty liver index for diagnosing NAFLD or inclusion of patients with end‐stage liver disease awaiting liver transplantation) or unavailability of extractable data for BMD, as specified in the PRISMA flow diagram.…”

“…Overall, 12 studies were eligible for inclusion in the meta‐analysis and were then assessed for quality . The main characteristics of the included studies are summarised in Table .…”

“…The diagnosis of NAFLD was based on liver biopsy (n = 1 study), ultrasonography (n = 10 studies), or vibration‐controlled transient elastography (Fibroscan) (n = 2 study), in the absence of excessive alcohol consumption and other known causes of chronic liver disease. In 10 of eligible studies, the outcome measure was BMD (as measured by DEXA at different skeletal sites) between patients with and without NAFLD, whereas in the remaining two studies the outcome measure was the history of osteoporotic fractures in patients with NAFLD compared with those without the disease . Most eligible studies were carried out in Asia (n = 10 studies mostly from China and South Korea); one study was carried out in the United States, and another one was carried out in Italy (including only post‐menopausal women with non‐insulin treated type 2 diabetes) .…”

“…Recently, the existence of a possible association between NAFLD and osteoporosis has created considerable scientific interest . Several observational cross‐sectional or case‐control studies have examined the association between imaging‐defined or biopsy‐proven NAFLD and BMD measurement in middle‐aged and elderly individuals . However, the findings from such studies have been inconsistent or conflicting so far, with some studies reporting a significant association between NAFLD and reduced BMD, especially in Chinese men, some studies reporting a significant association between NAFLD and increased BMD, and with others failing to find any significant association between NAFLD and BMD .…”