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Nonalcoholic fatty liver disease tied to increased osteoporotic fracture risk

24 Jan 2019

Individuals with imaging-defined or biopsy-proven nonalcoholic fatty liver disease (NAFLD) are likely to have a self‐reported history of osteoporotic fractures but not a low bone mineral density (BMD), according to a meta-analysis.

Researchers performed a systematic review of studies in which NAFLD was detected by imaging or histology, BMD was measured using dual energy X-ray absorptiometry, and a self-reported history of osteoporotic fractures was obtained with questionnaires.

The meta-analysis included 12 cross-sectional or case-control studies involving 30,041 middle-aged and elderly adults of predominantly Asian ethnicity (30 percent had NAFLD). Data were pooled using random-effects modelling.

Results revealed a significant association between NAFLD and increased odds of osteoporotic fractures (odds ratio [OR], 1.43; 95 percent CI, 1.0–2.06; I2, 55.1 percent). This association was pronounced in older Chinese men (OR, 2.10; 1.36–3.25; I2, 0 percent).

Conversely, no significant differences in BMD were seen at different skeletal sites (whole body, lumbar spine, or femur) between individuals with and without NAFLD. These findings were robust to sensitivity analyses. The funnel plot and Egger test did not show significant publication bias.

Researchers pointed out that the cross‐sectional design of the included studies prevented establishing temporal and causal relationships between NAFLD and the risk of osteoporotic fractures. However, it is biologically plausible that NAFLD may increase risk of osteoporotic fractures by exacerbating insulin resistance and triggering the release of multiple proinflammatory cytokines and bone‐influencing molecules that may promote bone demineralization and osteoporosis.

Additional large prospective studies and mechanistic studies are needed to elucidate the link between NAFLD, bone demineralization and long‐term fracture risk.

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