Increased risk of osteoporosis in lean/normal weight metabolic dysfunction‐associated fatty liver disease patients

Abstract Metabolic dysfunction‐associated fatty liver disease ( MAFLD ) was proposed with new diagnostic criteria, which involves hepatic steatosis and metabolic dysfunction in 2020. The relationship between MAFLD and osteoporosis is not well understood. This study included participants from the Taiwan Bio‐Bank cohort, where MAFLD was defined as hepatic steatosis plus having one of overweight/obesity, diabetes mellitus ( DM ), or ≥2 metabolic risk abnormalities in lean/normal weight subjects. Hepatic steatosis was diagnosed using liver ultrasonography, and osteoporosis was defined as T ‐scores <−2.5 using dual‐energy x‐ray absorptiometry. The final analysis included 22 554 participants (age 55.52 ± 10.31; males 35.95%), of which 39.1% were diagnosed with MAFLD and 16.9% had osteoporosis. Compared to non‐ MAFLD subjects, MAFLD patients were older, had a higher percentage of males and metabolic diseases including DM , hypertension and hyperlipidemia, higher levels of body mass index ( BMI ), ALT , and NAFLD fibrosis scores, but a lower percentage of osteoporosis. In univariate analysis, MAFLD had an inverse association with osteoporosis, but in multivariate analysis, it showed an increased probability of osteoporosis. Stepwise logistic regression revealed that BMI was the major confounding factor influencing the direction of association between MAFLD and osteoporosis. Subgroup analysis showed that MAFLD patients had a higher percentage and probability of osteoporosis than those without in subjects with BMI <23 kg/m 2 . In conclusion, the large database found the increased risk of osteoporosis exists only in MAFLD patients with lean/normal weight. Screening for bone health and preventive measures for osteoporosis should be undergone for these patients.