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.
Ciardullo, S., Muraca, E., Zerbini, F., Manzoni, G., Perseghin, G. (2021). NAFLD and liver fibrosis are not associated with reduced femoral bone mineral density in the general US population. THE JOURNAL OF CLINICAL ENDOCRINOLOGY AND METABOLISM, 106(8 (1 August 2021)), 2856-2865 [10.1210/clinem/dgab262].
NAFLD and liver fibrosis are not associated with reduced femoral bone mineral density in the general US population
Ciardullo, StefanoPrimo
;Perseghin, Gianluca
Ultimo
2021
Abstract
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.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.