Commentary
X. Zhu et al. (Division of Digestive and Liver Diseases, Comprehensive Transplant Center, Cedars Sinai Medical Center, Los Angeles, California) aimed to evaluate the association of NAFLD-associated hepatic fibrosis with bone mineral density in postmenopausal women with type 2 diabetes mellitus or impaired glucose regulation.
For this purpose, two cohorts including 46 subjects with biopsy-proven NAFLD and 445 subjects with proton magnetic resonance spectrum-proven NAFLD were enrolled in their study. Bone mineral density at the lumbar spine L1–L4 and hip was measured using dual-energy X-ray absorptiometry. NAFLD fibrosis stage and NAFLD fibrosis score were used to evaluate the severity of liver fibrosis.
In subjects with NAFLD, bone mineral density in the advanced fibrosis group were significantly lower than that in the non-advanced fibrosis group after adjusting for age, body mass index and fasting plasma glucose. These results were validated in a large cohort of 445 subjects. Additionally, bone metabolism-associated factors, including calcium and phosphate, were associated with liver fibrosis, indicating that bone metabolism may play a critical role in the association between liver fibrosis and bone mineral density.
Liver fibrosis decreased bone mineral density probably via increasing bone turnover.
