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Hepatic fibrosis is associated with an increased rate of decline in bone mineral density in men with nonalcoholic fatty liver disease

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Abstract

Background

There is still controversy about the association between nonalcoholic fatty liver disease (NAFLD) and bone mineral density (BMD). The aim of this study was to clarify the association between NAFLD and the decline in BMD in healthcare examinees.

Methods

Participants who underwent regular health check-ups with BMD and hepatic ultrasonography from 2006 to 2015 with more than one follow-up until 2020 were included. Propensity score matching was performed between the NAFLD group and the control group, and mixed linear regression models were used for the longitudinal analysis.

Results

Of 2623 eligible participants (mean age 58.7 ± 7.3 years; males 31.3%), 888 (33.9%) had NAFLD. At baseline, the NAFLD group had a higher total hip BMD than the non-NAFLD group in men (0.988 vs. 1.015 g/cm2, p = 0.007); however, there was no difference in baseline BMD in women (p = 0.253). In longitudinal analysis during a follow-up period of 7.1 years, there was no significant difference in the BMD decline rate between the two groups in the PS-matched cohort (p = 0.816 in men and p = 0.827 in women). However, among men with NAFLD, those with a high and intermediate probability of advanced fibrosis by the FIB-4 showed a significantly increased rate of decline in total hip BMD compared to those with low scores (0.01 vs. − 0.19% change/year, p = 0.011).

Conclusions

NAFLD was not associated with the total hip BMD decline rate. However, hepatic fibrosis was significantly associated with an increased rate of decline in total hip BMD in men with NAFLD.

Clinical trial registration

This study is a retrospective observational study and is not a drug trial. There was no need for clinical trial registration.

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Data availability

Datasets are available on request.

Abbreviations

ALT:

Alanine aminotransferase

AST:

Aspartate aminotransferase

BMI:

Body mass index

BMD:

Bone mineral density

FIB-4:

Fibrosis-4

GGT:

Gamma glutamyl transferase

HDL:

High-density lipoprotein

LDL:

Low-density lipoprotein

NAFLD:

Nonalcoholic fatty liver disease

NASH:

Nonalcoholic steatohepatitis

NFS:

NAFLD fibrosis score

PS:

Propensity score

SD:

Standard deviation

SMD:

Standardized mean difference

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Authors and Affiliations

  1. Department of Internal Medicine, Healthcare Research Institute, Healthcare System Gangnam Center, Seoul National University Hospital, 39FL., Gangnam Finance Center 737, Yeoksam-Dong, Gangnam-Gu, Seoul, 135-984, Republic of Korea

    Ji Won Yoon, Min Joo Kim, Goh-Eun Chung, Jong In Yang, Jeong Yoon Yim & Min-Sun Kwak

  2. Department of Obstetrics and Gynecology, Healthcare Research Institute, Healthcare System Gangnam Center, Seoul National University Hospital, Seoul, Republic of Korea

    Jin Ju Kim & Sun Mie Kim

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  1. Ji Won Yoon
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Contributions

JWY and MSK contributed to the study conception and design, acquisition of data, interpretation of data, drafting of the manuscript and statistical analysis. MJK, GEJ, JIY, JYY, JJK, and SMK contributed to the acquisition of data and critical revision of the manuscript for important intellectual content.

Corresponding author

Correspondence to Min-Sun Kwak.

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Conflict of interest

Ji Won Yoon, Min Joo Kim, Goh-Eun Chung, Jong In Yang, Jeong Yoon Yim, Jin Ju Kim, Sun Mie Kim, and Min-Sun Kwak declare no competing interests.

Research involved with animal participants

This was not an animal research.

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This was a retrospective study with clinical data collection, and the Institutional Review Board of Seoul National University Hospital approved to waive the patient consent.

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All the authors consented to publish work.

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Yoon, J.W., Kim, M.J., Chung, GE. et al. Hepatic fibrosis is associated with an increased rate of decline in bone mineral density in men with nonalcoholic fatty liver disease. Hepatol Int 15, 1347–1355 (2021). https://doi.org/10.1007/s12072-021-10254-y

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  • DOI: https://doi.org/10.1007/s12072-021-10254-y

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