Association between liver enzymes and bone mineral density in Koreans: a cross-sectional study

Abstract

BackgroundOsteoporosis is a major health concern for both men and women, and associated fractures incur substantial economic burden. While there are a multitude of studies on bone mineral density (BMD) and liver diseases, not many studies have assessed the association between liver enzyme levels and BMD in homogeneous populations.MethodsThe current study investigated the association between serum liver enzyme levels and BMD at various sites in Koreans. Out of 21,517 surveyees of the 5th Korean National Health and Nutrition Examination Survey (2010–2012), 7160 participants’ data on BMD, serum liver enzymes, and full covariate data were included for cross-sectional analysis. BMD at the femoral neck, lumbar spine, entire femur, and whole body was assessed using dual energy X-ray absorptiometry (DEXA), and liver enzymes included aspartate aminotransferase (AST), alanine aminotransferase (ALT), and gamma(γ)-glutamyl transferase (GGT) levels. Differences in participant characteristics by BMD and liver enzyme levels were analyzed, and complex sample design regression analysis adjusted for multiple covariates was performed to assess the relationship between liver enzymes and BMD.ResultsNegative associations were seen with GGT and BMD at all sites (P ≤ 0.02), ALT with lumbar spine (P = 0.0013), and AST with lumbar BMD (P = 0.0009). In particular, GGT presented strong negative associations with BMD in postmenopausal women and elder men.ConclusionsThis study demonstrates a negative relationship between liver enzyme levels and BMD, and suggests that a significant association exists between osteoporosis/decreased BMD and liver disorders.Electronic supplementary materialThe online version of this article (10.1186/s12891-018-2322-1) contains supplementary material, which is available to authorized users.

Association of bone mineral density with peripheral blood cell counts and hemoglobin in Chinese postmenopausal women

“…Previous studies have shown that OP is a common skeletal complication in patients with chronic liver disease, [ 20 , 21 ] and a cross-sectional study in Korea shows that there is a negative correlation between liver enzyme level and BMD, and there is a significant correlation between OP/BMD reduction and liver disease. [ 22 ] This is inconsistent with our results and may require further study (Table 5 ).…”

Association of gamma-glutamyl transferase variability with risk of osteoporotic fractures: A nationwide cohort study

“…In previous studies, increased blood GGT level has been associated with osteoporosis and decreased BMD. (3,10) These results support the possibility that GGT is involved in bone metabolism and may be associated with osteoporosis and related fractures. Moreover, variability in metabolic parameters, including GGT, is closely related to inflammation-associated metabolism and dysregulation of homeostasis, which may be associated with cardiovascular diseases and osteoporosis.…”

“…Recently, it has been reported that GGT level is also associated with other diseases including cardiovascular disease and osteoporosis and decreased bone mineral density (BMD) and with mortality as well. (1–3) To confirm the association between a specific biomarker and disease risk, it may be more reliable to determine whether variability in multiple measurements is more highly associated with risk than is change in only one measurement. In this context, GGT variability is closely related to risk of myocardial infarction, stroke, and heart failure.…”

Elevated gamma-glutamyl transpeptidase level is associated with an increased risk of hip fracture in postmenopausal women

“…In their study, being in the highest tertile of serum GGT level increased the risk of low bone mass, leading to osteopenia and osteoporosis. Another investigation including 7160 Koreans also demonstrated that GGT had a relatively clear negative association with BMD at multiple sites 25 . A study regarding the association between liver markers and short-term outcomes in patients with hip fracture demonstrated that higher GGT levels at the time of admission increased the risk of a prolonged hospital stay 26 .…”