Osteoporosis in patients with non-alcoholic fatty liver disease: a review of the literature

Background. Nonalcoholic fatty liver disease and osteoporosis are two common metabolic diseases. The prevalence of non-alcoholic fatty liver disease in populations is as high as 38%, with a much higher prevalence among obese and/or type 2 diabetics. The global prevalence of osteoporosis is estimated at 19.7%, varying considerably between countries and continents, and statistics show that the region and the level of solar activity do not determine the prevalence of the problem. Like non-alcoholic fatty liver disease, osteoporosis is latent for a long time, without a manifest clinical picture. It is quite logical to ask whether non-alcoholic fatty liver disease is an important component of the pathogenesis of osteoporosis or whether these are two frequently occurring diseases.

Objective. The objective of this literature review was to summarise the experimental and clinical evidence on the potential association between non-alcoholic fatty liver disease and osteoporosis.

Results. Non-alcoholic fatty liver disease as a manifestation of metabolic syndrome based on insulin resistance affects bone metabolism, increasing the risk of osteoporosis and its complications. Current literature suggests that non-alcoholic fatty liver disease affects bone metabolism in several ways: through alterations in systemic and local bone marrow immune status, modulating insulin-like growth factor-1 levels, gut microbiota composition, short-chain fatty acid metabolism and intestinal barrier integrity. Some studies have shown that bile acids produced by the liver have a protective effect on bone tissue. Bile acids are able to reprogram pro-inflammatory macrophages into their anti-inflammatory phenotypes, thereby reducing the degree of systemic inflammation. Normalising the interplay between the microbiome, immunity and bone metabolism may open new avenues for the treatment of osteoporosis in the future.

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