Association between Nonalcoholic Fatty Liver Disease (NAFLD) and Osteoporotic Fracture in Middle-Aged and Elderly Chinese

Context: Nonalcoholic fatty liver disease (NAFLD) has been considered as a hepatic manifestation of the metabolic syndrome and is associated with various metabolic abnormalities, which may link to an increased risk of osteoporotic fracture. However, epidemiological studies investigating the association between NAFLD and osteoporotic fracture were not available. Objective: The objective of the study was to determine whether NAFLD associates with osteoporotic fracture. Design, Setting, and Participants: This was a cross-sectional study of 7797 Chinese adults aged 40 yr or older in the Jiading District, Shanghai, China. Main Outcome Measures: A questionnaire, anthropometric measurements, laboratory tests, and a hepatic ultrasonic examination were conducted. NAFLD was diagnosed by hepatic ultrasound after the exclusion of alcohol abuse and other liver diseases. A history of fractures was collected with an interviewer-assisted questionnaire. Osteoporotic fractures were defined as fractures that occurred due to low-trauma in 2 yr prior to the study. Results: Among men, the prevalence of osteoporotic fractures was significantly higher in those with NAFLD (3.6 vs. 1.7%, P = 0.003); however, no difference was found in women (3.4 vs. 2.6%, P = 0.14). The presence of NAFLD was significantly associated with increased odds of osteoporotic fracture among men (odds ratio 2.53; 95% confidence interval 1.26-5.07; P = 0.009) after controlling for potential confounders. The significant associations were not detected in women. Conclusions: The presence of NAFLD was significantly associated with a recent history of osteoporotic fracture in middle-aged and elderly Chinese men. (J Clin Endocrinol Metab 97: 2033-2038, 2012)