Non-alcoholic fatty liver disease (NAFLD) is associated with an increased incidence of osteoporosis and bone fractures

Abstract

Background Non-alcoholic fatty liver disease (NAFLD) and osteoporosis are common diseases with a rising incidence worldwide. Both diseases occur in similar patient populations, however, data on their mutual influence are conflicting. Here, we aimed to evaluate the impact of NAFLD on the incidence of osteoporosis and fractures by using the Disease Analyzer database featuring data on diagnoses, prescriptions, and demographic aspects of 7.49 million cases followed in general practices in Germany.

Methods A total of 50,689 patients with NAFLD diagnosed between 2000 and 2015 were matched by age, sex, index year, and 3 comorbidities (obesity, diabetes mellitus, and vitamin D/calcium deficiency) to a cohort of equal size without NAFLD. Incidence of osteoporosis and bone fractures were compared between both groups within 10 years from the index date.

Results Within the observation period, the incidence of osteoporosis was significantly higher in the NAFLD group (6.4%) compared to patients without NAFLD (5.1%; log-rank, p < 0.001). Similar results were observed for bone fractures (12.6 vs. 10.3 %; log-rank p < 0.001). The difference was more pronounced in women compared to men and observed in all age groups >50 years of age.

Conclusion Our data show that NAFLD is significantly associated with osteoporosis as well as bone fractures in a large cohort of patients followed in German general practices. This finding suggests that NAFLD patients might benefit from improved monitoring for the occurrence of bone demineralization and osteoporosis, which in turn could trigger preventive therapeutic measures.

Zusammenfassung

Hintergrund Die nichtalkoholische Fettlebererkrankung (NAFLD) und Osteoporose sind häufige Erkrankungen mit weltweit steigender Inzidenz. Beide Erkrankungen treten in ähnlichen Patientenpopulationen auf, jedoch sind die Daten über ihren gegenseitigen Einfluss widersprüchlich. In dieser Studie verwendeten wir die Datenbank „Disease Analyzer“, die Daten zu Diagnosen, Verordnungen und demografischen Aspekten von 7,49 Millionen Patientenfällen in deutschen Hausarztpraxen enthält, um den Einfluss der NAFLD auf die Inzidenz von Osteoporose und Knochenfrakturen zu evaluieren.

Methoden Insgesamt 50.689 Patienten mit NAFLD, die zwischen 2000 und 2015 diagnostiziert wurden, wurden nach Alter, Geschlecht, Indexjahr und 3 Komorbiditäten (Adipositas, Diabetes mellitus und Vitamin-D-/Kalziummangel) mit einer gleich großen Kohorte von Patienten ohne NAFLD gepaart. Die Inzidenz von Osteoporose und Knochenbrüchen wurde zwischen beiden Gruppen über einen Zeitraum von 10 Jahren ab dem Indexdatum verglichen.

Ergebnisse Innerhalb des Beobachtungszeitraums war die Inzidenz von Osteoporose in der NAFLD-Gruppe signifikant höher (6,4 %) verglichen mit Patienten ohne NAFLD (5,1%; log-rank p<0,001). Ähnliche Ergebnisse wurden für Knochenfrakturen beobachtet (12,6 vs. 10,3%; log-rank p<0,001). Der Unterschied war bei Frauen im Vergleich zu Männern ausgeprägter und wurde in allen Altersgruppen >50 Jahre beobachtet.

Schlussfolgerung Unsere Daten zeigen, dass die NAFLD signifikant mit Osteoporose sowie Knochenbrüchen in einer großen Kohorte von Patienten, die in deutschen Allgemeinarztpraxen behandelt wurden, assoziiert ist. Dieser Befund sollte zu einer verbesserten Überwachung von NAFLD-Patienten hinsichtlich des Auftretens von Osteoporose führen, um entsprechende präventive und therapeutische Maßnahmen einleiten zu können.

Schlüsselwörter

Steatohepatits - NASH - Fettlebererkrankung - Leberzirrhose - Knochendichte

Keywords

Steatohepatitis - NASH - Fatty liver disease - Liver cirrhosis - Bone density

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