Association of non-alcoholic fatty liver disease and advanced liver fibrosis with osteoporosis in type 2 diabetes mellitus / 中华内分泌代谢杂志

ABSTRACT

Objective:To study the association of non-alcoholic fatty liver disease(NAFLD) and advanced liver fibrosis with osteoporosis in patients with type 2 diabetes mellitus(T2DM).Methods:Data was collected from 391 in-patients with type 2 diabetes mellitus(T2DM) from September 2019 to September 2020 at the Department of Endocrinology and Geriatric Medicine, Affiliated Huai′an First Hospital of Nanjing Medical University in this cross-sectional study. Participants were divided into T2DM with coexistent NAFLD(TCN) and with no NAFLD(TON) group via liver B-mode ultrasound.Also, the patients were divided into low and middle-high risk group via fibrosis index based on 4 factors index(FIB-4). Participant characteristics, laboratory results, and dual energy x-ray absorptiometry were obtained and analyzed. Multivariable logistic regression models were used to evaluate the association of NAFLD and advanced liver fibrosis with osteoporosis in T2DM. Interaction and stratified analyses were conducted according to age, sex, body mass index(BMI) and duration of diabetes(DD).Results:There was no significant difference in risk of osteoporosis and bone mineral density(BMD) loss between TCN and TON group(all P>0.05). After adjusting for age, sex, BMI, and DD, total hip BMD( β=-0.044, 95% CI -0.087--0.001, P=0.046) and lumbar L 1-L 4BMD( β=-0.044, 95% CI -0.087--0.002, P=0.044) were significantly reduced, and the risk of osteoporosis was significantly increased( OR=2.428, 95% CI 1.124-5.244, P=0.024) in FIB-4 middle-high risk group compared with low risk group. The subgroup analysis showed that overweight patients with T2DM had a significantly increased risk of osteoporosis( OR=4.240, 95% CI 1.637-10.987, interaction P=0.018) in FIB-4 middle-high risk group compared with low risk group. Conclusion:There was no significant difference in risk of osteoporosis and BMD loss between TCN and TON group. However, among T2DM patients who were overweight, NAFLD-related progressive liver fibrosis emerged as an independent risk factor for both BMD decline and the development of osteoporosis.