{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,15]],"date-time":"2026-05-15T07:43:19Z","timestamp":1778830999775,"version":"3.51.4"},"reference-count":39,"publisher":"Wiley","issue":"11","license":[{"start":{"date-parts":[[2025,8,13]],"date-time":"2025-08-13T00:00:00Z","timestamp":1755043200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J of Diabetes Invest"],"published-print":{"date-parts":[[2025,11]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Aim<\/jats:title>\n                    <jats:p>While both metabolic dysfunction\u2010associated fatty liver disease (MAFLD) and osteoporosis are closely linked to metabolic disorders, their relationship remains controversial. This study aimed to investigate the association between liver fibrosis and femoral neck bone mineral density (BMD) in MAFLD patients with type 2 diabetes mellitus (T2DM\u2010MAFLD) and to evaluate metabolic influences.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Materials and Methods<\/jats:title>\n                    <jats:p>We retrospectively enrolled 569 hospitalized T2DM\u2010MAFLD patients between September 2018 and May 2021. Liver fibrosis was assessed using the Fibrosis\u20104 score (FIB\u20104), and femoral neck BMD was measured by dual\u2010energy X\u2010ray absorptiometry. Generalized additive models evaluated non\u2010linear relationships, piecewise linear regression identified threshold effects, and stratified analyses explored metabolic modifiers.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      A non\u2010linear, inverted U\u2010shaped relationship was observed between FIB\u20104 and femoral neck BMD in postmenopausal women and men \u226550\u2009years, with a turning point at FIB\u20104\u2009=\u20092.091. Below this threshold, FIB\u20104 showed a significant positive correlation with femoral neck BMD (\n                      <jats:italic>\u03b2<\/jats:italic>\n                      \u2009=\u20090.039, 95%CI: 0.006\u20130.072,\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.020). Above the threshold, the association became negative but non\u2010significant (\n                      <jats:italic>\u03b2<\/jats:italic>\n                      \u2009=\u2009\u22120.032, 95%CI: \u22120.075 to 0.011,\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.141). Stratified analysis revealed that in patients with triglycerides \u22651.7\u2009mmol\/L, FIB\u20104 was significantly negatively correlated with femoral neck BMD (\n                      <jats:italic>\u03b2<\/jats:italic>\n                      \u2009=\u2009\u22120.025, 95%CI: \u22120.048, \u22120.003), with a significant interaction effect (\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.011).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>A non\u2010linear association between liver fibrosis and femoral neck BMD was observed in T2DM\u2010MAFLD patients, particularly postmenopausal women and men aged \u226550\u2009years, modulated by serum triglyceride. Hypertriglyceridemia may represent a crucial metabolic risk factor for osteoporosis development in MAFLD patients, suggesting the importance of bone loss screening in this patient population, particularly those with elevated triglycerides.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/jdi.70129","type":"journal-article","created":{"date-parts":[[2025,8,13]],"date-time":"2025-08-13T08:39:40Z","timestamp":1755074380000},"page":"2082-2091","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Non\u2010linear relationship between liver fibrosis and femoral neck bone mineral density in metabolic dysfunction\u2010associated fatty liver disease patients with type 2 diabetes mellitus"],"prefix":"10.1111","volume":"16","author":[{"given":"Jie","family":"Tao","sequence":"first","affiliation":[{"name":"Department of General Practice The Affiliated Huaian No. 1 People's Hospital of Nanjing Medical University  Huai'an Jiangsu China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lin","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of General Practice The Affiliated Huaian No. 1 People's Hospital of Nanjing Medical University  Huai'an Jiangsu China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Honggang","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Health Management Center The Affiliated Huaian No. 1 People's Hospital of Nanjing Medical University  Huai'an Jiangsu China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3871-2711","authenticated-orcid":false,"given":"Juan","family":"Tan","sequence":"additional","affiliation":[{"name":"Department of General Practice The Affiliated Huaian No. 1 People's Hospital of Nanjing Medical University  Huai'an Jiangsu China"},{"name":"Department of Health Management Center The Affiliated Huaian No. 1 People's Hospital of Nanjing Medical University  Huai'an Jiangsu 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