Association between nonalcoholic fatty liver disease and bone mineral density in postmenopausal women

Objective: Growing evidence suggests that nonalcoholic fatty liver disease (NAFLD) is associated with reduced bone mineral density (BMD). This study examined the association between NAFLD and BMD in postmenopausal Korean women.Methods: This retrospective cross-sectional study analyzed 3739 postmenopausal women aged 50-59years who visited a health promotion center for a routine checkup from 2009 to 2014. Menopause was defined as absence of menstruation for 12months and an elevated follicle-stimulating hormone serum level (>20IU/L). Women were excluded if they had a history of disease or use of medication that might affect bone metabolism. NAFLD was diagnosed by ultrasonography; BMD was measured by dual-energy X-ray absorptiometry. BMDs were compared according to the presence of NAFLD, and associations between NAFLD and BMD were analyzed after adjustment.Results: Among 3739 postmenopausal women, 605 (16.2%) had NAFLD. Mean BMD at the lumbar spine (P=0.017) and femur neck (P<0.0001) was significantly lower in women with NAFLD than in those without NAFLD. Associations between NAFLD and BMD were significantly negative at both sites after adjusting for potential clinical confounders and factors which were significantly associated with BMD.Conclusions: NAFLD is negatively associated with BMD in postmenopausal women. A longitudinal study is recommended.