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

Journal of Preventive Medicine and Public Health 2020년 53권 5호 p.342 ~ 352
Sung Ji-Sun, 류승호, 송윤미, 정해관,
소속 상세정보
 ( Sung Ji-Sun ) - Sungkyunkwan University School of Medicine Department of Social and Preventive Medicine
류승호 ( Ryu Seung-Ho ) - Sungkyunkwan University School of Medicine Kangbuk Samsung Hospital Department of Occupational and Environmental Medicine
송윤미 ( Song Yun-Mi ) - Sungkyunkwan University School of Medicine Samsung Medical Center Department of Family Medicine
정해관 ( Cheong Hae-Kwan ) - Sungkyunkwan University School of Medicine Department of Social and Preventive Medicine

Abstract


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.

Method: 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.

키워드

Non-alcoholic fatty liver disease; Obesity; Bone density; Osteoporosis; Cohort studies

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