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Journal of Endocrinological Investigation
Published in: Journal of Endocrinological Investigation 8/2015

01-08-2015 | Review

Nonalcoholic fatty liver disease and decreased bone mineral density: is there a link?

Authors: G. Targher, A. Lonardo, M. Rossini

Published in: Journal of Endocrinological Investigation | Issue 8/2015

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Abstract

Purpose

Liver diseases are associated with decreased bone mineral density (BMD) and evidence suggests that nonalcoholic fatty liver disease (NAFLD) affects several extra-hepatic organs, interacting with the regulation of multiple endocrine and metabolic pathways. This review focuses on the rapidly expanding body of evidence that supports a strong association between NAFLD and the risk of decreased BMD, expression of low bone mass (osteoporosis), or reduced mineralization (osteomalacia).

Methods

We identified studies by searching PubMed for original articles published in English through March 2015 using the keywords “nonalcoholic fatty liver disease” or “fatty liver” combined with “bone mineral density”, “osteoporosis”, or “osteomalacia”.

Results

Recent cross-sectional and case–control studies involving both adults and children have consistently shown that patients with NAFLD exhibit a greater prevalence of decreased BMD compared with age-, sex-, and body mass index-matched healthy controls. Accumulating clinical and experimental evidence suggests that NAFLD may contribute to the pathophysiology of low BMD, possibly through the direct contribution of NAFLD to whole-body and hepatic insulin resistance and/or the systemic release of multiple pro-inflammatory, pro-coagulant, and pro-fibrogenic mediators.

Conclusions

Although more research is needed before firm conclusions can be drawn, it appears that there is a non-chance, statistical association between NAFLD and low BMD. This finding argues for more careful monitoring and evaluation of BMD among patients with NAFLD. The potential contribution of NAFLD itself to the development and progression of decreased BMD warrants further study.
Literature
1.
Chalasani N, Younossi Z, Lavine JE, Diehl AM, Brunt EM, Cusi K, Charlton M, Sanyal AJ, American Association for the Study of Liver Diseases; American College of Gastroenterology; American Gastroenterological Association (2012) The diagnosis and management of non-alcoholic fatty liver disease: practice guideline by the American Association for the Study of Liver Diseases, American College of Gastroenterology, and the American Gastroenterological Association. Am J Gastroenterol 107:811–826PubMedCrossRef
2.
Anstee QM, Targher G, Day CP (2012) Progression of NAFLD to diabetes mellitus, cardiovascular disease or cirrhosis. Nat Rev Gastroenterol Hepatol 10:330–344CrossRef
3.
Lonardo A, Ballestri S, Marchesini G, Angulo P, Loria P (2015) NAFLD a precursor of the metabolic syndrome. Dig Liv Dis 47:181–190CrossRef
4.
Armstrong MJ, Adams LA, Canbay A, Syn WK (2014) Extrahepatic complications of nonalcoholic fatty liver disease. Hepatology 59:1174–1197PubMedCrossRef
5.
Targher G, Day CP, Bonora E (2010) Risk of cardiovascular disease in patients with nonalcoholic fatty liver disease. N Engl J Med 363:1341–1350PubMedCrossRef
6.
Targher G, Chonchol M, Pichiri I, Zoppini G (2011) Risk of cardiovascular disease and chronic kidney disease in diabetic patients with non-alcoholic fatty liver disease: just a coincidence? J Endocrinol Invest 34:544–551PubMed
7.
Ballestri S, Lonardo A, Bonapace S, Byrne CD, Loria P, Targher G (2014) Risk of cardiovascular, cardiac and arrhythmic complications in patients with non-alcoholic fatty liver disease. World J Gastroenterol 20:1724–1745PubMedCentralPubMedCrossRef
8.
Targher G, Chonchol MB, Byrne CD (2014) CKD and nonalcoholic fatty liver disease. Am J Kidney Dis 64:638–652PubMedCrossRef
9.
Pirgon O, Bilgin H, Tolu I, Odabas D (2011) Correlation of insulin sensitivity with bone mineral status in obese adolescents with nonalcoholic fatty liver disease. Clin Endocrinol (Oxf) 75:189–195CrossRef
10.
Campos RM, de Piano A, da Silva PL, Carnier J, Sanches PL, Corgosinho FC, Masquio DC, Lazaretti-Castro M, Oyama LM, Nascimento CM, Tock L, de Mello MT, Tufik S, Dâmaso AR (2012) The role of pro/anti-inflammatory adipokines on bone metabolism in NAFLD obese adolescents: effects of long-term interdisciplinary therapy. Endocrine 42:146–156PubMedCrossRef
11.
Pardee PE, Dunn W, Schwimmer JB (2012) Non-alcoholic fatty liver disease is associated with low bone mineral density in obese children. Aliment Pharmacol Ther 35:248–254PubMedCrossRef
12.
Purnak T, Beyazit Y, Ozaslan E, Efe C, Hayretci M (2012) The evaluation of bone mineral density in patients with nonalcoholic fatty liver disease. Wien Klin Wochenschr 124:526–531PubMedCrossRef
13.
Moon SS, Lee YS, Kim SW (2012) Association of nonalcoholic fatty liver disease with low bone mass in postmenopausal women. Endocrine 42:423–429PubMedCrossRef
14.
Li M, Xu Y, Xu M, Ma L, Wang T, Liu Y, Dai M, Chen Y, Lu J, Liu J, Bi Y, Ning G (2012) Association between nonalcoholic fatty liver disease (NAFLD) and osteoporotic fracture in middle-aged and elderly Chinese. J Clin Endocrinol Metab 97:2033–2038PubMedCrossRef
15.
Pacifico L, Bezzi M, Lombardo CV, Romaggioli S, Ferraro F, Bascetta S, Chiesa C (2013) Adipokines and C-reactive protein in relation to bone mineralization in pediatric nonalcoholic fatty liver disease. World J Gastroenterol 19:4007–4014PubMedCentralPubMedCrossRef
16.
Bhatt SP, Nigam P, Misra A, Guleria R, Qadar Pasha MA (2013) Independent associations of low 25-hydroxyvitamin D and high parathyroid hormonal levels with nonalcoholic fatty liver disease in Asian Indians residing in north India. Atherosclerosis 230:157–163PubMedCrossRef
17.
Cui R, Sheng H, Rui XF, Cheng XY, Sheng CJ, Wang JY, Qu S (2013) Low bone mineral density in Chinese adults with nonalcoholic fatty liver disease. Int J Endocrinol 2013:396545PubMedCentralPubMedCrossRef
18.
19.
Arikan S, Tuzcu A, Bahceci M, Ozmen S, Gokalp D (2012) Insulin resistance in type 2 diabetes mellitus may be related to bone mineral density. J Clin Densitom 15:186–190PubMedCrossRef
20.
Faulhaber GA, Premaor MO, Moser Filho HL, Silla LM, Furlanetto TW (2009) Low bone mineral density is associated with insulin resistance in bone marrow transplant subjects. Bone Marrow Transpl 43:953–957CrossRef
21.
Greco EA, Francomano D, Fornari R, Marocco C, Lubrano C, Papa V, Wannenes F, Di Luigi L, Donini LM, Lenzi A, Aversa A, Migliaccio S (2013) Negative association between trunk fat, insulin resistance and skeleton in obese women. World J Diabetes 4:31–39PubMedCentralPubMedCrossRef
22.
Redlich K, Smolen JS (2012) Inflammatory bone loss: pathogenesis and therapeutic intervention. Nat Rev Drug Discov 11:234–250PubMedCrossRef
23.
Zou W, Hakim I, Tschoep K, Endres S, Bar-Shavit Z (2001) Tumor necrosis factor-alpha mediates RANK ligand stimulation of osteoclast differentiation by an autocrine mechanism. J Cell Biochem 83:70–83PubMedCrossRef
24.
Nanes MS (2003) Tumor necrosis factor-alpha: molecular and cellular mechanisms in skeletal pathology. Gene 321:1–15PubMedCrossRef
25.
Lee HL, Yi T, Woo KM, Ryoo HM, Kim GS, Baek JH (2010) Msx2 mediates the inhibitory action of TNF alpha on osteoblast differentiation. Exp Mol Med 42:437–445PubMedCentralPubMedCrossRef
26.
Ochi H, Hara Y, Tagawa M, Shinomiya K, Asou Y (2010) The roles of TNFR1 in lipopolysaccharide induced bone loss: dual effects of TNFR1 on bone metabolism via osteoclastogenesis and osteoblast survival. J Orthop Res 28:657–663PubMed
27.
Peterson CA, Heffernan ME (2008) Serum tumor necrosis factor-alpha concentrations are negatively correlated with serum 25(OH)D concentrations in healthy women. J Inflamm (Lond) 5:10CrossRef
28.
Syn WK, Choi SS, Liaskou E, Karaca GF, Agboola KM, Oo YH, Mi Z, Pereira TA, Zdanowicz M, Malladi P, Chen Y, Moylan C, Jung Y, Bhattacharya SD, Teaberry V, Omenetti A, Abdelmalek MF, Guy CD, Adams DH, Kuo PC, Michelotti GA, Whitington PF, Diehl AM (2011) Osteopontin is induced by hedgehog pathway activation and promotes fibrosis progression in nonalcoholic steatohepatitis. Hepatology 53:106–115PubMedCentralPubMedCrossRef
29.
Fujisawa R, Tamura M (2012) Acidic bone matrix proteins and their roles in calcification. Front Biosci 17:1891–1903CrossRef
30.
Ishijima M, Rittling SR, Yamashita T, Tsuji K, Kurosawa H, Nifuji A, Denhardt DT, Noda M (2001) Enhancement of osteoclastic bone resorption and suppression of osteoblastic bone formation in response to reduced mechanical stress do not occur in the absence of osteopontin. J Exp Med 193:399–404PubMedCentralPubMedCrossRef
31.
Confavreux CB (2011) Bone: from a reservoir of minerals to a regulator of energy metabolism. Kidney Int 79(suppl 121):S14–S19CrossRef
32.
Chapman J, Miles PD, Ofrecio JM, Neels JG, Yu JG, Resnik JL, Wilkes J, Talukdar S, Thapar D, Johnson K, Sears DD (2010) Osteopontin is required for the early onset of high fat diet-induced insulin resistance in mice. PLoS One 5:e13959PubMedCentralPubMedCrossRef
33.
Chang IC, Chiang TI, Yeh KT, Lee H, Cheng YW (2010) Increased serum osteopontin is a risk factor for osteoporosis in menopausal women. Osteoporos Int 21:1401–1409PubMedCrossRef
34.
Kennedy OD, Brennan O, Rackard SM, Staines A, O’Brien FJ, Taylor D, Lee TC (2009) Effects of ovariectomy on bone turnover, porosity, and biomechanical properties in ovine compact bone 12 months postsurgery. J Orthop Res 27:303–309PubMedCrossRef
35.
Reid P, Holen I (2009) Pathophysiological roles of osteoprotegerin (OPG). Eur J Cell Biol 88:1–17PubMedCrossRef
36.
Blázquez-Medela AM, López-Novoa JM, Martínez-Salgado C (2011) Osteoprotegerin and diabetes associated pathologies. Curr Mol Med 11:401–416PubMedCrossRef
37.
Yilmaz Y, Yonal O, Kurt R, Oral AY, Eren F, Ozdogan O, Ari F, Celikel CA, Korkmaz S, Ulukaya E, Imeryuz N, Kalayci C, Avsar E (2010) Serum levels of osteoprotegerin in the spectrum of nonalcoholic fatty liver disease. Scand J Clin Lab Invest 70:541–546PubMedCrossRef
38.
Patterson-Buckendahl P (2011) Osteocalcin is a stress-responsive neuropeptide. Endocr Regul 45:99–110PubMedCrossRef
39.
Pietschmann P, Resch H, Krexner E, Woloszczuk W, Willvonseder R (1991) Decreased serum osteocalcin levels in patients with postmenopausal osteoporosis. Acta Med Austriaca 18:114–116PubMed
40.
Fernandez-Real JM, Ortega F, Gómez-Ambrosi J, Salvador J, Frühbeck G, Ricart W (2010) Circulating osteocalcin concentrations are associated with parameters of liver fat infiltration and increase in parallel to decreased liver enzymes after weight loss. Osteoporos Int 21:2101–2107PubMedCrossRef
41.
Yilmaz Y, Kurt R, Eren F, Imeryuz N (2011) Serum osteocalcin levels in patients with nonalcoholic fatty liver disease: association with ballooning degeneration. Scand J Clin Lab Invest 71:631–636PubMedCrossRef
42.
Dou J, Ma X, Fang Q, Hao Y, Yang R, Wang F, Zhu J, Bao Y, Jia W (2013) Relationship between serum osteocalcin levels and non-alcoholic fatty liver disease in Chinese men. Clin Exp Pharmacol Physiol 40:282–288PubMedCrossRef
43.
Minokoshi Y, Kim YB, Peroni OD, Fryer LG, Müller C, Carling D, Kahn BB (2002) Leptin stimulates fatty-acid oxidation by activating AMP-activated protein kinase. Nature 415:339–343PubMedCrossRef
44.
Ebihara K, Kusakabe T, Hirata M, Masuzaki H, Miyanaga F, Kobayashi N, Tanaka T, Chusho H, Miyazawa T, Hayashi T, Hosoda K, Ogawa Y, DePaoli AM, Fukushima M, Nakao K (2007) Efficacy and safety of leptin-replacement therapy and possible mechanisms of leptin actions in patients with generalized lipodystrophy. J Clin Endocrinol Metab 92:532–541PubMedCrossRef
45.
Polyzos SA, Kountouras J, Mantzoros CS (2015) Leptin in nonalcoholic fatty liver disease: a narrative review. Metabolism 64:60–78PubMedCrossRef
46.
Yadav VK, Oury F, Suda N, Liu ZW, Gao XB, Confavreux C, Klemenhagen KC, Tanaka KF, Gingrich JA, Guo XE, Tecott LH, Mann JJ, Hen R, Horvath TL, Karsenty G (2009) A serotonin-dependent mechanism explains the leptin regulation of bone mass, appetite, and energy expenditure. Cell 138:976–989PubMedCentralPubMedCrossRef
47.
Zeadin MG, Butcher MK, Shaughnessy SG, Werstuck GH (2012) Leptin promotes osteoblast differentiation and mineralization of primary cultures of vascular smooth muscle cells by inhibiting glycogen synthase kinase (GSK)-3b. Biochem Biophys Res Commun 425:924–930PubMedCrossRef
48.
DeMambro VE, Maile L, Wai C, Kawai M, Cascella T, Rosen CJ, Clemmons D (2012) Insulin-like growth factor-binding protein-2 is required for osteoclast differentiation. J Bone Miner Res 27:390–400PubMedCentralPubMedCrossRef
49.
Tsuji K, Maeda T, Kawane T, Matsunuma A, Horiuchi N (2010) Leptin stimulates fibroblast growth factor-23 expression in bone and suppresses renal 1alpha,25-dihydroxyvitamin D3 synthesis in leptin-deficient ob/ob mice. J Bone Miner Res 25:1711–1723PubMedCrossRef
50.
Dimitri P, Jacques RM, Paggiosi M, King D, Walsh J, Taylor ZA, Frangi AF, Bishop N, Eastell R (2014) Leptin may play a role in bone microstructural alterations in obese children. J Clin Endocrinol Metab 100:594–602PubMedCrossRef
51.
Musso G, Gambino R, Cassader M (2010) Emerging molecular targets for the treatment of non-alcoholic fatty liver disease. Annu Rev Med 61:375–392PubMedCrossRef
52.
Ramezani-Moghadam M, Wang J, Ho V, Iseli TJ, Alzahrani B, Xu A, van der Poorten D, Qiao L, George J, Hebbard L (2015) Adiponectin reduces hepatic stellate cell migration by promoting tissue inhibitor of metalloproteinase-1 (TIMP-1) secretion. J Biol Chem 290:5533–5542PubMedCrossRef
53.
Luo XH, Guo LJ, Xie H, Yuan LQ, Wu XP, Zhou HD, Liao EY (2006) Adiponectin stimulates RANKL and inhibits OPG expression in human osteoblasts through the MAPK signaling pathway. J Bone Miner Res 21:1648–1656PubMedCrossRef
54.
Williams GA, Wang Y, Callon KE, Watson M, Lin JM, Lam JB, Costa JL, Orpe A, Broom N, Naot D, Reid IR, Cornish J (2009) In vitro and in vivo effects of adiponectin on bone. Endocrinology 150:3603–3610PubMedCrossRef
55.
Wang QP, Yang L, Li XP, Xie H, Liao EY, Wang M, Luo XH (2012) Effects of 17-beta-estradiol on adiponectin regulation of the expression of osteoprotegerin and receptor activator of nuclear factor-kB ligand. Bone 51:515–523PubMedCrossRef
56.
Tu Q, Zhang J, Dong LQ, Saunders E, Luo E, Tang J, Chen J (2011) Adiponectin inhibits osteoclastogenesis and bone resorption via APPL1-mediated suppression of Akt1. J Biol Chem 286:12542–12553PubMedCentralPubMedCrossRef
57.
Targher G, Pichiri I, Lippi G (2012) Vitamin D, thrombosis, and hemostasis: more than skin deep. Semin Thromb Hemost 38:114–124PubMedCrossRef
58.
Targher G, Bertolini L, Scala L, Cigolini M, Zenari L, Falezza G, Arcaro G (2007) Associations between serum 25-hydroxyvitamin D3 concentrations and liver histology in patients with nonalcoholic fatty liver disease. Nutr Metab Cardiovasc Dis 17:517–524PubMedCrossRef
59.
Barchetta I, Angelico F, Del Ben M, Baroni MG, Pozzilli P, Morini S (2011) Cavallo MG (2011) Strong association between non-alcoholic fatty liver disease (NAFLD) and low 25(OH)-vitamin D levels in an adult population with normal serum liver enzymes. BMC Med 9:85PubMedCentralPubMedCrossRef
60.
Targher G, Scorletti E, Mantovani A, Byrne CD (2013) Nonalcoholic fatty liver disease and reduced serum vitamin D3 levels. Metab Syndr Relat Disord 11:217–228PubMedCrossRef
61.
Nobili V, Giorgio V, Liccardo D, Bedogni G, Morino G, Alisi A, Cianfarani S (2014) Vitamin D levels and liver histological alterations in children with nonalcoholic fatty liver disease. Eur J Endocrinol 170:547–553PubMedCrossRef
62.
Barchetta I, Carotti S, Labbadia G, Gentilucci UV, Muda AO, Angelico F, Silecchia G, Leonetti F, Fraioli A, Picardi A, Morini S, Cavallo MG (2012) Liver vitamin D receptor, CYP2R1, and CYP27A1 expression: relationship with liver histology and vitamin D3 levels in patients with nonalcoholic steatohepatitis or hepatitis C virus. Hepatology 56:2180–2187PubMedCrossRef
63.
Laird E, McNulty H, Ward M, Hoey L, Mc Sorley E, Wallace JM, Carson E, Molloy AM, Healy M, Casey MC, Cunningham C, Strain JJ (2014) Vitamin D deficiency is associated with inflammation in older Irish adults. J Clin Endocrinol Metab 99:1807–1815PubMedCrossRef
64.
Villaggio B, Soldano S, Cutolo M (2012) 1,25-dihydroxyvitamin D3 down-regulates aromatase expression and inflammatory cytokines in human macrophages. Clin Exp Rheumatol 30:934–938PubMed
65.
Hallsworth K, Thoma C, Moore S, Ploetz T, Anstee QM, Taylor R, Day CP, Trenell MI (2015) Nonalcoholic fatty liver disease is associated with higher levels of objectively measured sedentary behaviour and lower levels of physical activity than matched healthy controls. Frontline Gastroenterol 6:44–51PubMedCentralPubMedCrossRef
66.
Chastin SF, Mandrichenko O, Helbostadt JL, Skelton DA (2014) Associations between objectively measured sedentary behaviour and physical activity with bone mineral density in adults and older adults, the NHANES study. Bone 64:254–262PubMedCrossRef
67.
Choudhary NS, Tomar M, Chawla YK, Bhadada SK, Khandelwal N, Dhiman RK, Duseja A, Bhansali A (2011) Hepatic osteodystrophy is common in patients with noncholestatic liver disease. Dig Dis Sci 56:3323–3327PubMedCrossRef
68.
Santori C, Ceccanti M, Diacinti D, Attilia ML, Toppo L, D’Erasmo E, Romagnoli E, Mascia ML, Cipriani C, Prastaro A, Carnevale V, Minisola S (2008) Skeletal turnover, bone mineral density, and fractures in male chronic abusers of alcohol. J Endocrinol Invest 31:321–326PubMedCrossRef
69.
Yurci A, Yucesoy M, Unluhizarci K, Torun E, Gursoy S, Baskol M, Guven K, Ozbakir O (2011) Effects of testosterone gel treatment in hypogonadal men with liver cirrhosis. Clin Res Hepatol Gastroenterol 35:845–854PubMedCrossRef
70.
Bang UC, Benfield T, Bendtsen F, Hyldstrup L, Beck Jensen JE (2014) The risk of fractures among patients with cirrhosis or chronic pancreatitis. Clin Gastroenterol Hepatol 12:320–326PubMedCrossRef
71.
Sinclair M, Grossmann M, Gow PJ, Angus PW (2015) Testosterone in men with advanced liver disease: abnormalities and implications. J Gastroenterol Hepatol 30:244–251PubMedCrossRef
72.
Lonardo A, Adinolfi LE, Loria P, Carulli N, Ruggiero G, Day CP (2004) Steatosis and hepatitis C virus: mechanisms and significance for hepatic and extra-hepatic disease. Gastroenterology 126:586–597PubMedCrossRef
73.
Lonardo A, Adinolfi LE, Restivo L, Ballestri S, Romagnoli D, Baldelli E, Nascimbeni F, Loria P (2014) Pathogenesis and significance of hepatitis C virus steatosis: an update on survival strategy of a successful pathogen. World J Gastroenterol 20:7089–7103PubMedCentralPubMedCrossRef
74.
Orsini LG, Pinheiro MM, Castro CH, Silva AE, Szejnfeld VL (2013) Bone mineral density measurements, bone markers and serum vitamin D concentrations in men with chronic non-cirrhotic untreated hepatitis C. PLoS One 8:e81652PubMedCentralPubMedCrossRef
75.
Ohlsson C, Sjögren K (2015) Effects of the gut microbiota on bone mass. Trends Endocrinol Metab 26:69–74PubMedCrossRef
76.
Mehal WZ (2013) The Gordian Knot of dysbiosis, obesity and NAFLD. Nat Rev Gastroenterol Hepatol 10:637–644PubMedCrossRef
77.
78.
Metadata
Title
Nonalcoholic fatty liver disease and decreased bone mineral density: is there a link?
Authors
G. Targher
A. Lonardo
M. Rossini
Publication date
01-08-2015
Publisher
Springer International Publishing
Published in
Journal of Endocrinological Investigation / Issue 8/2015
Electronic ISSN: 1720-8386
DOI
https://doi.org/10.1007/s40618-015-0315-6

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