NAFLD and Liver Fibrosis Are Not Associated With Reduced Femoral Bone Mineral Density in the General US Population.
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, the major predictor of future development of liver-related events in NAFLD, has an influence on BMD.


OBJECTIVE
To assess whether liver steatosis and fibrosis are associated with reduced BMD in the general US population.


METHODS
We performed a 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. We included all participants older than 50 years with reliable VCTE and femoral neck DXA results (925 men and 859 women). The main outcome measures were 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 smoking, and diabetes, neither CAP nor LSM were significantly associated with reduced BMD in both sexes.


CONCLUSION
Liver steatosis and fibrosis are not associated with femoral DXA-based diagnosis of osteopenia or osteoporosis in the US population older than 50 years.
['Ciardullo|Stefano|S|0000-0003-2422-3041', 'Muraca|Emanuele|E|0000-0003-1796-4511', 'Zerbini|Francesca|F|', 'Manzoni|Giuseppina|G|', 'Perseghin|Gianluca|G|0000-0002-3024-0457']
D015502:Absorptiometry, Photon D015519:Bone Density D003430:Cross-Sectional Studies D054459:Elasticity Imaging Techniques D005260:Female D005269:Femur D006801:Humans D008103:Liver Cirrhosis D008297:Male D008875:Middle Aged D065626:Non-alcoholic Fatty Liver Disease D009749:Nutrition Surveys D010024:Osteoporosis D012307:Risk Factors D014481:United States
NAFLD bone osteoporosis Fibroscan MAFLD