Association Between Liver Fibrosis and Physical Activity with Bone Mineral Density in Korean Adults

PURPOSE: This study aimed to investigate the association among liver fibrosis, physical activity, and bone mineral density in Korean adults.METHODS: Data from 8,019 participants aged 40–69 years in the 2008–2011 Korea National Health and Nutrition Examination Survey (KNHANES) were analyzed. Bone mineral density was measured using dual-energy X-ray bone densitometry (DXA). Liver fibrosis was defined using the fibrosis-4 (FIB-4) index. Physical activity was evaluated using the International Physical Activity Questionnaire (IPAQ). Logistic regression analysis was used to examine the associations among liver fibrosis, physical activity, and osteoporosis.RESULTS: Participants with liver fibrosis had a significantly higher risk of osteoporosis (OR=1.857, 95% CI=1.682-2.051, p<.001) compared to those without fibrosis. Similarly, physically inactive participants had a higher risk of osteoporosis (OR=1.392, 95% CI=1.273-1.523, p<.001) than physically active participants. After adjusting for age and sex, compared to the normal/active group (reference=1), the normal/inactive (OR=1.299, 95% CI=1.155-1.461, p<.001) and fibrosis/inactive groups (OR=1.243, 95% CI=1.058-1.461, p=.008) had a significantly higher risk of osteoporosis. Furthermore, after further adjustment for education, marital status, region, income, smoking, and chronic diseases, the association remained significant in the normal/inactive group (OR=1.279, 95% CI=1.137-1.439, p<.001) and fibrosis/inactive group (OR=1.216, 95% CI=1.033-1.431, p=.019). However, after further adjustment for body mass index, the association remained significant in the normal/inactive group (OR=1.213, 95% CI=1.074-1.370, p=.002).CONCLUSIONS: Our results suggest that physical activity is associated with the attenuation of the risk of osteoporosis associated with liver fibrosis. However, further studies are required to determine the relationship between other covariates and osteoporosis.