{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T19:53:31Z","timestamp":1789588411347,"version":"build-2803163510"},"reference-count":32,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2021,3,31]],"date-time":"2021-03-31T00:00:00Z","timestamp":1617148800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Endocrinol."],"abstract":"<jats:sec><jats:title>Objective<\/jats:title><jats:p>Nonalcoholic fatty liver disease (NAFLD) and sarcopenia, which are common in elderly men, are known as risk factors of fracture. However, few studies have examined the association with fracture in these patients. Therefore, we aimed to investigate the association between NAFLD with or without sarcopenia and 10-year fracture probability in Korean men aged \u226550 years.<\/jats:p><\/jats:sec><jats:sec><jats:title>Materials and Methods<\/jats:title><jats:p>Data of 2,525 individuals from the 2010\u20132011 Korea National Health and Nutrition Examination Survey were analyzed. NAFLD was defined using the fatty liver index (FLI) and comprehensive NAFLD score (CNS), and liver fibrosis using the fibrosis 4 calculator. Sarcopenia was defined as the lowest quintile for sex-specific sarcopenia index cutoff; values. The Fracture Risk Assessment (FRAX) tool was used to predict the 10-year probability of major osteoporotic and hip fractures.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Compared to the no NAFLD group, the 10-year major osteoporotic fracture probability was significantly associated with the FLI-defined (\u03b2 = 0.16, P = 0.002) and CNS-defined (\u03b2 = 0.20, P &amp;lt; 0.001) NAFLD groups with liver fibrosis. Similarly, the 10-year hip fracture probability was significantly associated with the FLI- and CNS-defined NAFLD with liver fibrosis groups compared to the group without NAFLD (FLI-defined group, \u03b2 = 0.04, P = 0.046; CNS-defined group, \u03b2 = 0.05, P = 0.048). Furthermore, in the group with sarcopenia, the 10-year major osteoporotic fracture probability was significantly associated with the FLI- and CNS-defined NAFLD with liver fibrosis groups compared to the group without NAFLD (FLI-defined group, \u03b2 = 0.29, P = 0.003; CNS-defined group, \u03b2 = 0.38, P &amp;lt; 0.001).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>NAFLD with liver fibrosis is significantly associated with a higher 10-year major osteoporotic and hip fracture probability in Korean men aged \u226550 years, and this positive association was more profound in patients with sarcopenia. Therefore, screening middle-aged to elderly men who have NAFLD combined with liver fibrosis and sarcopenia may help prevent fractures.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fendo.2021.599339","type":"journal-article","created":{"date-parts":[[2021,3,31]],"date-time":"2021-03-31T06:36:41Z","timestamp":1617172601000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":17,"title":["Association Between 10-Year Fracture Probability and Nonalcoholic Fatty Liver Disease With or Without Sarcopenia in Korean Men: A Nationwide Population-Based Cross-Sectional Study"],"prefix":"10.3389","volume":"12","author":[{"given":"Hye Jun","family":"Lee","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Duk Chul","family":"Lee","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Choon Ok","family":"Kim","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2021,3,31]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","DOI":"10.1007\/s00198-006-0172-4","article-title":"An estimate of the worldwide prevalence and disability associated with osteoporotic fractures","volume":"17","author":"Johnell","year":"2006","journal-title":"Osteoporos Int"},{"key":"B2","unstructured":"Case finding for the management of osteoporosis with FRAX \u2013 assessment and intervention thresholds for the UK\n            KanisJA\n            McCloskeyEV\n            JohanssonH\n            StromO\n            BorgstromF\n            OdenA\n          2008"},{"key":"B3","doi-asserted-by":"publisher","DOI":"10.1007\/s00198-013-2595-z","article-title":"Percentage of the population at high risk of osteoporotic fracture in South Korea: analysis of the 2010 Fifth Korean National Health and Nutrition Examination survey data","volume":"25","author":"Kim","year":"2014","journal-title":"Osteoporos Int"},{"key":"B4","doi-asserted-by":"publisher","DOI":"10.1007\/s00774-011-0279-3","article-title":"The incidence and residual lifetime risk of osteoporosis-related fractures in Korea","volume":"29","author":"Park","year":"2011","journal-title":"J Bone Miner Metab"},{"key":"B5","doi-asserted-by":"publisher","DOI":"10.1053\/gast.2002.34168","article-title":"Expanding the natural history of nonalcoholic steatohepatitis: from cryptogenic cirrhosis to hepatocellular carcinoma","volume":"123","author":"Bugianesi","year":"2002","journal-title":"Gastroenterology"},{"key":"B6","doi-asserted-by":"publisher","DOI":"10.1210\/jc.2011-3010","article-title":"Association between nonalcoholic fatty liver disease (NAFLD) and osteoporotic fracture in middle-aged and elderly Chinese","volume":"97","author":"Li","year":"2012","journal-title":"J Clin Endocrinol Metab"},{"key":"B7","doi-asserted-by":"publisher","DOI":"10.1007\/s40618-016-0528-3","article-title":"Association between bone mineral density and nonalcoholic fatty liver disease in Korean adults","volume":"39","author":"Lee","year":"2016","journal-title":"J\u00a0Endocrinol Invest"},{"key":"B8","doi-asserted-by":"publisher","DOI":"10.1002\/hep.21852","article-title":"Bone disorders in chronic liver disease","volume":"46","author":"Collier","year":"2007","journal-title":"Hepatology"},{"key":"B9","doi-asserted-by":"publisher","DOI":"10.1007\/s00508-012-0211-4","article-title":"The evaluation of bone mineral density in patients with nonalcoholic fatty liver disease","volume":"124","author":"Purnak","year":"2012","journal-title":"Wien Klin Wochenschr"},{"key":"B10","doi-asserted-by":"publisher","DOI":"10.1111\/j.1478-3231.2006.01311.x","article-title":"Prevalence of primary non-alcoholic fatty liver disease in a population-based study and its association with biochemical and anthropometric measures","volume":"26","author":"Zelber-Sagi","year":"2006","journal-title":"Liver Int"},{"key":"B11","doi-asserted-by":"publisher","DOI":"10.4103\/sjg.SJG_237_17","article-title":"Sarcopenia and risk of nonalcoholic fatty liver disease: A meta-analysis","volume":"24","author":"Wijarnpreecha","year":"2018","journal-title":"Saudi J Gastroenterol"},{"key":"B12","doi-asserted-by":"publisher","DOI":"10.14336\/AD.2014.0500226","article-title":"Managing sarcopenia and its related-fractures to improve quality of life in geriatric populations","volume":"5","author":"Hida","year":"2013","journal-title":"Aging Dis"},{"key":"B13","doi-asserted-by":"publisher","DOI":"10.4254\/wjh.v9.i6.326","article-title":"Sarcopenia and non-alcoholic fatty liver disease: Is there a relationship? 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