Non-alcoholic fatty liver disease and osteoporosis: a bi-directional association

Osteoporosis is a serious public health concern worldwide, characterized by decreased bone mineral density (BMD) and impaired microarchitecture of bone tissue, leading to an increased incidence of low-trauma fractures. Osteoporosis typically affects older adults, but it can also occur at younger ages due to impaired absorption of calcium and vitamin D in various gastrointestinal (GI) diseases. NAFLD is a risk factor for decreased bone mineral density (BMD). New data on the pathophysiological changes in bone tissue in NAFLD are presented: release of inflammatory cytokines, decreased secretion of molecules directly affecting bone (strengthening bone) from the liver affected by NAFLD, impaired vitamin D metabolism, and impaired intestinal microbiota. NAFLD is a risk factor for decreased BMD. Further research is needed to confirm the physiological significance of NAFLD with regard to the risk of osteoporotic bone fractures. Mandatory osteoporosis screening and bone health monitoring in patients with NAFLD may be possible in future NAFLD management strategies and guidelines.