Nonalcoholic Fatty Liver Disease and Bone Health Dynamics

Nonalcoholic fatty liver disease (NAFLD) encompasses a spectrum of hepatic steatosis not caused by excessive alcohol intake, affecting a growing proportion of the global population. Beyond its hepatic manifestations, NAFLD is increasingly recognised as a multisystem disorder with consequences for skeletal integrity. Chronic hepatic fat accumulation and associated metabolic dysfunction can disrupt the endocrine crosstalk between liver and bone, leading to imbalances in bone remodelling. Mechanisms include insulin resistance, chronic low-grade inflammation, altered secretion of osteotropic factors such as osteoprotegerin and receptor activator of NF-κB ligand, vitamin D insufficiency and perturbations in calcium homoeostasis. Clinically, these processes manifest as reduced bone mineral density (BMD), osteopenia, osteoporosis and an elevated fracture risk. The intersection of NAFLD with ageing, obesity and type 2 diabetes mellitus underscores its global significance, emphasising the need for integrated screening, preventive strategies and multidisciplinary management to preserve skeletal health in affected individuals.

Research from Nature Portfolio

A cross-sectional investigation among adults in Upper Egypt has provided clear evidence that NAFLD is associated with a marked reduction in BMD and a higher prevalence of osteoporosis. Individuals with ultrasound-diagnosed hepatic steatosis exhibited significantly lower hip and femoral neck BMD compared with matched controls. These patients also showed reduced serum vitamin D and calcium levels, while parathyroid hormone measurements remained within reference ranges. Moreover, diminished vitamin D emerged as an independent predictor of osteoporosis in the NAFLD cohort. These findings highlight the importance of routine bone health assessment and vitamin D status monitoring in patients with fatty liver, particularly in regions with limited resources.

Nonalcoholic Fatty Liver Disease and Bone Health Dynamics publication trend

The graph below shows the total number of articles in nonalcoholic fatty liver disease and bone health dynamics across all publications each year (not limited to Nature Index journals).

Technical terms

Nonalcoholic fatty liver disease (NAFLD): Hepatic fat accumulation not due to excessive alcohol consumption.

Bone mineral density (BMD): The amount of mineral matter per square centimetre of bone, reflecting bone strength.

Osteopenia and osteoporosis: Conditions of reduced BMD; osteoporosis represents a more severe loss with heightened fracture risk.

Insulin resistance: A state in which cells exhibit a diminished response to insulin, contributing to metabolic disturbances.

Osteoprotegerin/RANKL axis: A regulatory system controlling osteoclast differentiation and activity, critical for bone remodelling.

Transient elastography: A non-invasive ultrasound-based method for quantifying liver stiffness and steatosis.

References

1. Osteoprotegerin/Receptor Activator of Nuclear Factor-Kappa B Ligand/Receptor Activator of Nuclear Factor-Kappa B Axis in Obesity, Type 2 Diabetes Mellitus, and Nonalcoholic Fatty Liver Disease. Current Obesity Reports (2023).
2. Non-Alcoholic Fatty Liver Disease and Bone Tissue Metabolism: Current Findings and Future Perspectives. International Journal of Molecular Sciences (2023).
3. Non-alcoholic fatty liver disease is associated with decreased bone mineral density in upper Egyptian patients. Scientific Reports (2023).
4. Prevalence and Trends in Low Bone Density, Osteopenia and Osteoporosis in U.S. Adults With Non-Alcoholic Fatty Liver Disease, 2005–2014. Frontiers in Endocrinology (2022).
5. Association of Metabolic Dysfunction-Associated Fatty Liver Disease and Liver Stiffness With Bone Mineral Density in American Adults. Frontiers in Endocrinology (2022).