Bone Turnover Markers in Adults with Nonalcoholic Fatty Liver Disease: A Systematic Review and Meta-Analysis

Abstract

Objective. Previous studies suggested that the level of bone turnover markers (BTMs) could be altered in patients with nonalcoholic fatty liver disease (NAFLD). We aim to provide a comprehensive understanding on the associations between BTMs and NAFLD in adults with a meta-analysis. Methods. Articles published up to January 31, 2023, were systematically searched in PubMed, Web of Science, Cochrane database, Embase, and CNKI. The search formula is as follows: “nonalcoholic fatty liver disease” combined with the terms that bone turnover markers such as “osteocalcin,” “collagen type I trimeric cross-linked peptide,” and “procollagen type I N-terminal peptide.” Stata 15.0 software was used to calculate the pooled OR (95% CI) and perform the heterogeneity test, sensitivity analysis, and publication bias. Results. We identified 18 studies with a total of 12,310 participants. Statistical differences were found between patients with NAFLD compared to the control group for osteocalcin (n = 15 studies; SMD: −0.69; 95% CI: −0.73–−0.64; $P=0.002$ ), procollagen type I N-terminal propeptide (n = 5 studies; SMD: −0.40; 95% CI: −0.80−−0.00; $P=0.049$ ), and collagen type I cross-linked C-telopeptide (n = 7 studies; SMD: −0.16; 95% CI: −0.23−−0.09); $P<0.001$ ). Conclusion. Bone turnover markers were lower in patients with NAFLD compared to the control group.