Korean J Fam Pract. 2018; 8(2): 259-265  https://doi.org/10.21215/kjfp.2018.8.2.259
The Association between the Non-Alcoholic Fatty Liver Disease and the Rate of Bone Mineral Density Decline
Ah Young Eo, Jae Moon Yun*, Sang Hyuck Kim, Su Min Jeong, Soo Jin Wang, Yoon Jung Cho
Department of Family Medicine, Seoul National University Hospital, Seoul, Korea
Jae Moon Yun
Tel: +82-2-2072-0847, Fax: +82-2-766-3276
E-mail: jaemoon2@gmail.com
ORCID: http://orcid.org/0000-0003-0927-4721
Received: March 16, 2017; Revised: July 22, 2017; Accepted: July 30, 2017; Published online: April 20, 2018.
© The Korean Academy of Family Medicine. All rights reserved.

This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted noncommercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Abstract
Background: In some studies, osteoporosis and osteoporotic fractures were closely related to metabolic disorders, such as central obesity and insulin resistance. As nonalcoholic fatty liver disease (NAFLD) is recognized as a hepatic manifestation of metabolic syndrome, we investigated the association between NAFLD and the rate of decline in bone mineral density (BMD).
Methods: We conducted a study with 2,606 Korean adults who had undergone a health checkup in a third-degree hospital at least twice between 2006 and 2013. We excluded other potential causes of liver diseases, such as viral hepatitis and heavy drinking. Abdominal ultrasonography was conducted for diagnosis of fatty liver, and BMDs were measured using dual-energy X-ray absorptiometry. The rate of decline in BMD was defined as the difference between the baseline and subsequent BMDs, divided by the time interval.
Results: For this study, 2,386 subjects were enrolled. In model 1 (adjusted for age, body mass index, and waist circumference) and model 2 (adjusted for model 1 plus smoking status, alanine aminotransferase level, and fasting plasma glucose level), NAFLD was not significantly associated with BMD change in both the men and women. However, in the subgroup analysis for postmenopausal women, a positive correlation was found between NAFLD and lumbar spine BMD (model 1: β=0.0071, P=0.044; model 2: β=0.0085, P=0.018).
Conclusion: In general, no significant association was found between NAFLD and the rate of bone loss. However, in postmenopausal women, NAFLD had a positive effect on the rate of L-spine BMD decline. Further long-term studies would be essential for clarifying the association between NAFLD and BMD.
Keywords: Nonalcoholic Fatty Liver Disease; Osteoporosis; Bone Density; Metabolic Syndrome; Insulin Resistance
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