title: Nonalcoholic fatty liver disease and decreased bone mineral density: is there a link?
abstract: OBJECTIVE
  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.
authors.affiliation: Section of Endocrinology, Diabetes and Metabolism, Department of Medicine, University and Azienda Ospedaliera Universitaria Integrata of Verona, Piazzale Stefani, 1, 37126, Verona, Italy, giovanni.targher@univr.it.
authors.forename: G
authors.initials: G
authors.lastname: Targher
authors.forename: A
authors.initials: A
authors.lastname: Lonardo
authors.forename: M
authors.initials: M
authors.lastname: Rossini
mesh_terms: D000818:Animals; D015519:Bone Density / Q000502:physiology*; D001851:Bone Diseases, Metabolic / Q000175:diagnosis / Q000453:epidemiology* / Q000378:metabolism*; D016022:Case-Control Studies; D003430:Cross-Sectional Studies; D006801:Humans; D065626:Non-alcoholic Fatty Liver Disease / Q000175:diagnosis / Q000453:epidemiology* / Q000378:metabolism*; D010024:Osteoporosis / Q000175:diagnosis / Q000453:epidemiology / Q000378:metabolism