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Significant liver fibrosis assessed using liver transient elastography is independently associated with low bone mineral density in patients with non-alcoholic fatty liver disease.

 Gyuri Kim  ;  Kwang Joon Kim  ;  Yumie Rhee  ;  Sung-Kil Lim  ;  Salvatore Petta 
 PLOS ONE, Vol.12(7) : e0182202, 2017 
Journal Title
Issue Date
Aged ; Bone Density ; Bone Diseases, Metabolic/diagnostic imaging ; Bone Diseases, Metabolic/epidemiology ; Elasticity Imaging Techniques ; Female ; Femur/diagnostic imaging ; Humans ; Liver Cirrhosis/complications ; Liver Cirrhosis/diagnostic imaging ; Lumbar Vertebrae/diagnostic imaging ; Male ; Middle Aged ; Non-alcoholic Fatty Liver Disease/complications ; Non-alcoholic Fatty Liver Disease/diagnostic imaging ; Non-alcoholic Fatty Liver Disease/pathology

Metabolic bone disorders frequently occur in patients with chronic liver disease; however, the association between liver fibrosis and bone mineral density in patients with non-alcoholic fatty liver disease (NAFLD) is unclear.


This is a cross-sectional analysis of 231 asymptomatic subjects (160 women, 61.6 years old) from a university hospital setting, between February 2012 and December 2014. Bone mineral density (BMD) was measured at the lumbar spine, femur neck, and total hip using dual-energy X-ray absorptiometry (DXA). Liver fibrosis and steatosis were assessed using transient elastography.


Among a total of 231 individuals, 129 subjects (55.8%) had NAFLD. BMDs at lumbar spine, femur neck, and total hip were significantly lower in patients having NAFLD with significant fibrosis, compared with patients having NAFLD without significant fibrosis (Ps<0.005). In patients with NAFLD, significant liver fibrosis revealed marked negative correlations with BMD at the lumber spine (r = -0.19, P = 0.032), femur neck (r = -0.19, P = 0.034), and total hip (r = -0.21, P = 0.016). A multivariate linear regression analysis revealed that significant liver fibrosis was independently correlated with low BMD at the femur neck (β = -0.18, P = 0.039) and total hip (β = -0.21, P = 0.005) after adjustment for age, sex, BMI, fasting plasma glucose, alanine aminotransferase, high-density lipoprotein cholesterol, and liver steatosis among patients with NAFLD. Using multivariable logistic regression, significant liver fibrosis was independently associated with overall osteopenia and osteoporosis in subjects having NAFLD (OR = 4.10, 95% CI = 1.02-16.45).


The presence of significant liver fibrosis assessed via TE was independently associated with low BMD in NAFLD subjects.
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1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
Yonsei Authors
Kim, Kwang Joon(김광준) ORCID logo https://orcid.org/0000-0002-5554-8255
Kim, Gyuri(김규리)
Rhee, Yumie(이유미) ORCID logo https://orcid.org/0000-0003-4227-5638
Lim, Sung Kil(임승길)
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