{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,12]],"date-time":"2026-10-12T22:13:49Z","timestamp":1791843229590,"version":"4.3.4"},"reference-count":37,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2023,12,4]],"date-time":"2023-12-04T00:00:00Z","timestamp":1701648000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100003392","name":"Natural Science Foundation of Fujian Province","doi-asserted-by":"publisher","award":["No. 2020J011245, No. 2019WJ39, No. 2022J011426"],"award-info":[{"award-number":["No. 2020J011245, No. 2019WJ39, No. 2022J011426"]}],"id":[{"id":"10.13039\/501100003392","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Endocrinol."],"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>Existing evidence on the associations of liver steatosis and fibrosis with bone mineral density (BMD) and risk of osteopenia\/osteoporosis was limited with conflicting results. We aimed to evaluate the associations of metabolic dysfunction-associated fatty liver disease (MAFLD) and hepatic fibrosis with BMD and risk of osteopenia\/osteoporosis in type 2 diabetes mellitus (T2DM) patients.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Baseline information of an ongoing cohort of 249 T2DM patients in Xiamen, China was analyzed. MAFLD was defined as the presence of hepatic steatosis [diagnosed by either hepatic ultrasonography scanning or fatty liver index (FLI) score &amp;gt;60] for T2DM patients. BMD was measured using dual-energy x-ray absorptiometry at total lumbar (L2\u20134), femur neck (FN), and total hip (TH) and was categorized as normal (T \u2265 \u22121.0), osteopenia (\u22122.5 &amp;lt; T &amp;lt; \u22121.0), or osteoporosis (T \u2264 \u22122.5) according to its minimum T-score.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Among the 249 T2DM patients, prevalence rates of MAFLD, osteopenia, and osteoporosis were 57.8%, 50.6%, and 17.7%, respectively. Patients with MAFLD had significantly higher BMD T-scores of L2\u20134, FN, and TH and the minimum as well as lower prevalence of osteoporosis than patients without MAFLD. Hepatic steatosis indices, including FLI score, fatty liver (FLI \u2265 60 or hepatic ultrasonography scanning), and MAFLD, were significantly and positively associated with all T-scores, while hepatic fibrosis index and FIB-4 score, but not NAFLD fibrosis score (NFS), were negatively associated with all T-scores. MAFLD was significantly associated with the decreased risk of osteopenia\/osteoporosis and osteoporosis with unadjusted odds ratios (ORs) (95% CI) of 0.565 (0.324\u20130.987) and 0.434 (0.224\u20130.843) (both <jats:italic>p<\/jats:italic>-values &amp;lt; 0.05), respectively. As for liver fibrosis, FIB-4 score, but not NFS, was significantly associated with elevated risk of osteoporosis with an unadjusted OR (95% CI) per SD increase of FIB-4 score of 1.446 (1.080\u20131.936, <jats:italic>p<\/jats:italic>-value = 0.013). Adjusting for potential confounding variables, especially body mass index, in the multivariable regression analyses, all associations of hepatic steatosis and fibrosis indices with BMD and risk of osteopenia\/osteoporosis were not statistically significant.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>MAFLD and hepatic fibrosis were not significantly associated with BMD and risk of osteopenia\/osteoporosis independent of obesity. Nevertheless, screening and management of MAFLD and osteopenia\/osteoporosis were still important for the prevention of fracture in T2DM patients.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fendo.2023.1278505","type":"journal-article","created":{"date-parts":[[2023,12,4]],"date-time":"2023-12-04T06:53:15Z","timestamp":1701672795000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":31,"title":["Associations of metabolic dysfunction-associated fatty liver disease and hepatic fibrosis with bone mineral density and risk of osteopenia\/osteoporosis in T2DM 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