Increased risk of osteoporosis in patients with nonalcoholic fatty liver disease: A population-based retrospective cohort study

Chen, Hong-Jhe

doi:10.1016/j.afos.2017.08.002

Cited by 7 publications

(12 citation statements)

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“…It should also be noted that after the study selection process and the final extraction of data for this meta‐analysis were concluded (as of 31 August 2018), a further retrospective cohort study was published examining the association between NAFLD and risk of developing osteoporosis . Using the National Health Insurance Research Database in Taiwan (including two separate cohorts: 4318 patients with NAFLD and 17 272 patients without NAFLD, who were followed for a median period of ~10 years), Chen et al reported that the risk of newly‐diagnosed osteoporosis (based on the diagnostic codes of the International Classification of Diseases [ICD, 9th revision]) was 1.35 times higher in patients with ICD‐defined NAFLD, especially among those with coexisting chronic pulmonary diseases and diabetes, than in their counterparts without NAFLD . However, further long‐term and well‐designed prospective studies are needed to address the association between NAFLD and risk of incident osteoporosis.…”

Section: Discussionmentioning

confidence: 99%

“…21,22 It should also be noted that after the study selection process and times higher in patients with ICD-defined NAFLD, especially among those with coexisting chronic pulmonary diseases and diabetes, than in their counterparts without NAFLD. 35 However, further long-term and well-designed prospective studies are needed to address the association between NAFLD and risk of incident osteoporosis.…”

Section: Discussionmentioning

confidence: 99%

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Systematic review with meta‐analysis: non‐alcoholic fatty liver disease is associated with a history of osteoporotic fractures but not with low bone mineral density

Mantovani

Dauriz

Gatti

et al. 2019

Aliment Pharmacol Ther

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Summary Background Several studies have explored the effect of non‐alcoholic fatty liver disease (NAFLD) on bone mineral density (BMD) and risk of osteoporotic fractures in adults. However, the extent to which NAFLD adversely affects bone health remains uncertain. Aim To provide a quantitative estimation of the magnitude of the association of NAFLD with BMD or history of osteoporotic fractures in adults. Methods We searched PubMed, Web of Science, and Scopus using predefined keywords to identify all observational studies, published up to 31 August 2018, in which NAFLD was diagnosed by imaging or histology; BMD was measured by dual energy X‐ray absorptiometry; and a self‐reported history of osteoporotic fractures was collected with interviewer‐assisted questionnaires. Data from selected studies were extracted, and meta‐analysis was performed using random‐effects modelling. Results Twelve cross‐sectional or case‐control studies with aggregate data on 30 041 adults of predominantly Asian ethnicity (30% with NAFLD) were included in the final analysis. No significant differences in BMD at different skeletal sites (whole body, lumbar spine, or femur) were observed between individuals with and without NAFLD. Conversely, NAFLD was associated with increased odds of osteoporotic fractures, especially in older Chinese men (n = 2 studies; random‐effects odds ratio 2.10, 95% CI 1.36‐3.25; I2 = 0%). Sensitivity analyses did not alter these findings. The funnel plot and Egger test did not reveal significant publication bias. Conclusions This meta‐analysis suggests that imaging‐defined or biopsy‐proven NAFLD is associated with a self‐reported history of osteoporotic fractures (principally in Chinese men), but not with low BMD, in middle‐aged and elderly individuals.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Systematic review with meta‐analysis: non‐alcoholic fatty liver disease is associated with a history of osteoporotic fractures but not with low bone mineral density

Mantovani

Dauriz

Gatti

et al. 2019

Aliment Pharmacol Ther

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“…Additionally, NAFLD is clinically relevant to the development of extrahepatic diseases, [1,6] including GD. [3] Physicians should pay special attention to patients with NAFLD and provide them with information about extrahepatic diseases, including GD. Specific lifestyle modifications (ie, weight loss, smoking cessation, calorie-restricted diet, and increasing physical activity) should be emphasized for NAFLD patients, and physicians should consider prescribing aggressive pharmaceutical modifications in NAFLD patients with metabolic syndrome or type 2 diabetes mellitus to decrease the morbidity, mortality, and medical expenses associated with extrahepatic diseases, [26] including GD.…”

Section: Discussionmentioning

confidence: 99%

The grade of nonalcoholic fatty liver disease is an independent risk factor for gallstone disease

2019

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There have been reports linking nonalcoholic fatty liver disease (NAFLD) with gallstone disease (GD) owing to shared risk factors. However, there are no reported associations between the different NAFLD grades and GD. This study aimed to determine whether NAFLD grade is an independent risk factor for GD in a Korean population. This study enrolled 7886 participants who completed a questionnaire and underwent medical examination and ultrasound scanning at the Health Promotion Center of Jeju National University Hospital in Korea, from January 2009 to December 2017. Fatty liver grading and presence of gallstones were investigated using abdominal ultrasound. Body mass index and biochemical parameters were measured, and age, sex, and metabolic syndrome status were collected from medical records. Univariate and multivariate analyses were performed to identify risk factors for GD. The estimated prevalences of NAFLD and GD were 40.6% and 4.5%, respectively. In the univariate analysis, factors associated with GD were age; NAFLD; presence of metabolic syndrome; and levels of fasting blood glucose, high-density lipoproteins, aspartate aminotransferase, and alanine aminotransferase. Multivariate logistic regression analysis revealed older age and higher NAFLD grade as independent risk factors for GD. Older age and higher grade of NAFLD were independent risk factors for GD in our cohort. There was a strong correlation between grade of NAFLD on abdominal ultrasonography and GD.

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“…Compared to the previous cohort studies, our study had some strengths. We considered a wider variety of possible confounders, such as insulin resistance, than a Taiwanese cohort study that only considered comorbidities using National Health Insurance Research Database information [ 22 ]. Additionally, while the accuracy of diagnosis in health insurance data is generally low, in this study, fatty liver was confirmed via ultrasonography and normal BMD at baseline was ensured via DXA examinations.…”

Section: Discussionmentioning

confidence: 99%

“…In contrast, cross-sectional studies in adults have shown sex-dependent results, with a consistent negative association between NAFLD and BMD in males and an inconsistent association in females [ 18 - 21 ]. Recently, 2 Chinese cohort studies reported that NAFLD was a significant risk factor for developing osteoporosis or decreased BMD regardless of sex [ 22 , 23 ]. Chen et al [ 22 ] reported that the risk of developing osteoporosis was 1.35 times higher in the NAFLD cohort of that study than in the control cohort, and Shen et al [ 23 ] reported that the risk of developing low BMD was 2.24 times higher in the NAFLD group than in the non-NAFLD group.…”

Section: Introductionmentioning

confidence: 99%

Relationship Between Non-alcoholic Fatty Liver Disease and Decreased Bone Mineral Density: A Retrospective Cohort Study in Korea

Sung

Ryu

Song

et al. 2020

J Prev Med Public Health

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Objectives The aim of this retrospective cohort study was to investigate whether non-alcoholic fatty liver disease (NAFLD) was associated with incident bone mineral density (BMD) decrease. Methods This study included 4536 subjects with normal BMD at baseline. NAFLD was defined as the presence of fatty liver on abdominal ultrasonography without significant alcohol consumption or other causes. Decreased BMD was defined as a diagnosis of osteopenia, osteoporosis, or BMD below the expected range for the patient’s age based on dual-energy X-ray absorptiometry. Cox proportional hazards models were used to estimate the hazard ratio of incident BMD decrease in subjects with or without NAFLD. Subgroup analyses were conducted according to the relevant factors. Results Across 13 354 person-years of total follow-up, decreased BMD was observed in 606 subjects, corresponding to an incidence of 45.4 cases per 1000 person-years (median follow-up duration, 2.1 years). In the model adjusted for age and sex, the hazard ratio was 0.65 (95% confidence interval, 0.51 to 0.82), and statistical significance disappeared after adjustment for body mass index (BMI) and cardiometabolic factors. In the subgroup analyses, NAFLD was associated with a lower risk of incident BMD decrease in females even after adjustment for confounders. The direction of the effect of NAFLD on the risk of BMD decrease changed depending on BMI category and body fat percentage, although the impact was statistically insignificant. Conclusions NAFLD had a significant protective effect on BMD in females. However, the effects may vary depending on BMI category or body fat percentage.

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Increased risk of osteoporosis in patients with nonalcoholic fatty liver disease: A population-based retrospective cohort study

Cited by 7 publications

References 0 publications

Systematic review with meta‐analysis: non‐alcoholic fatty liver disease is associated with a history of osteoporotic fractures but not with low bone mineral density

Systematic review with meta‐analysis: non‐alcoholic fatty liver disease is associated with a history of osteoporotic fractures but not with low bone mineral density

The grade of nonalcoholic fatty liver disease is an independent risk factor for gallstone disease

Relationship Between Non-alcoholic Fatty Liver Disease and Decreased Bone Mineral Density: A Retrospective Cohort Study in Korea

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