Associations of metabolic dysfunction-associated fatty liver disease and hepatic fibrosis with bone mineral density and risk of osteopenia/osteoporosis in T2DM patients

Abstract

BackgroundExisting evidence on the associations of liver steatosis and fibrosis with bone mineral density (BMD) and risk of osteopenia/osteoporosis was limited with conflicting results. We aimed to evaluate the associations of metabolic dysfunction-associated fatty liver disease (MAFLD) and hepatic fibrosis with BMD and risk of osteopenia/osteoporosis in type 2 diabetes mellitus (T2DM) patients.MethodsBaseline information of an ongoing cohort of 249 T2DM patients in Xiamen, China was analyzed. MAFLD was defined as the presence of hepatic steatosis [diagnosed by either hepatic ultrasonography scanning or fatty liver index (FLI) score >60] for T2DM patients. BMD was measured using dual-energy x-ray absorptiometry at total lumbar (L2–4), femur neck (FN), and total hip (TH) and was categorized as normal (T ≥ −1.0), osteopenia (−2.5 < T < −1.0), or osteoporosis (T ≤ −2.5) according to its minimum T-score.ResultsAmong the 249 T2DM patients, prevalence rates of MAFLD, osteopenia, and osteoporosis were 57.8%, 50.6%, and 17.7%, respectively. Patients with MAFLD had significantly higher BMD T-scores of L2–4, FN, and TH and the minimum as well as lower prevalence of osteoporosis than patients without MAFLD. Hepatic steatosis indices, including FLI score, fatty liver (FLI ≥ 60 or hepatic ultrasonography scanning), and MAFLD, were significantly and positively associated with all T-scores, while hepatic fibrosis index and FIB-4 score, but not NAFLD fibrosis score (NFS), were negatively associated with all T-scores. MAFLD was significantly associated with the decreased risk of osteopenia/osteoporosis and osteoporosis with unadjusted odds ratios (ORs) (95% CI) of 0.565 (0.324–0.987) and 0.434 (0.224–0.843) (both p-values < 0.05), respectively. As for liver fibrosis, FIB-4 score, but not NFS, was significantly associated with elevated risk of osteoporosis with an unadjusted OR (95% CI) per SD increase of FIB-4 score of 1.446 (1.080–1.936, p-value = 0.013). Adjusting for potential confounding variables, especially body mass index, in the multivariable regression analyses, all associations of hepatic steatosis and fibrosis indices with BMD and risk of osteopenia/osteoporosis were not statistically significant.ConclusionMAFLD and hepatic fibrosis were not significantly associated with BMD and risk of osteopenia/osteoporosis independent of obesity. Nevertheless, screening and management of MAFLD and osteopenia/osteoporosis were still important for the prevention of fracture in T2DM patients.

Correlation Between Thyroid-Stimulating Hormone (TSH) and Liver Function Test Values in North Karnataka Patients Admitted to a Tertiary Care Hospital

“…The First Affiliated Hospital of Xiamen University performed a cross-sectional study from 2017 to 2020 [13], but they could not find a clear link between T3 levels and the severity of liver fibrosis in people with type 2 diabetes mellitus (T2DM) and nonalcoholic fatty liver disease (NAFLD) [13,14]. Recent research has unveiled that diminished thyroid function is linked to a heightened risk of advanced fibrosis in individuals with metabolic dysfunction-associated fatty liver disease (MAFLD), indicating that thyroid activity may play a role in liver health [15][16][17][18]. Furthermore, studies on morbidly obese patients showed a positive association between TSH and the risk of hepatic steatosis, as well as between higher levels of free thyroxine (FT4) and lower levels of free triiodothyronine (FT3) with higher levels of total bilirubin [19][20][21][22][23].…”

Regulation of bone homeostasis: signaling pathways and therapeutic targets

“… 4 In addition, many inflammatory conditions, such as periprosthetic osteolysis (PPO), osteoarthritis (OA), rheumatic arthritis(RA), osteonecrosis of the femoral head(ONFH), Paget's disease of bone (PDB) and bone tumors, lead to excessive bone resorption as well as impaired bone formation. 5 It has been approximated that more than 200 million people are impacted by osteoporosis globally, 6 and bone loss‐related diseases have become a global burden on our aging society. 7 Thus, maintaining homeostatic balance and ensuring the health of bone tissue are of paramount importance.…”