# Metabolic Dysfunction Associated Steatotic Liver Disease and Bone Turnover Markers in Postmenopausal Women: A Cross‐Sectional Study in Central Nepal

## TL;DR

This study found that postmenopausal women with fatty liver disease had altered bone markers, suggesting a link between liver health and bone metabolism.

## Contribution

The study is the first to explore the relationship between MASLD and bone turnover markers in postmenopausal women in Nepal.

## Key findings

- Women with MASLD had significantly lower serum calcium and higher phosphorus and ALP levels compared to non-MASLD women.
- BMI and waist circumference were significant factors influencing bone marker differences between the groups.
- No significant age or blood pressure differences were observed between MASLD and non-MASLD groups.

## Abstract

Metabolic dysfunction‐associated steatotic liver disease, a condition of fatty infiltration in the liver, is mostly observed in women. Women after menopause are more likely to develop insulin resistance, hyperlipidemia, and visceral fat storage, which are all recognized to be risk factors for MASLD. Chronic low‐grade inflammation in hepatocytes, which is a hallmark of MASLD, may significantly affect bone metabolism. This study aimed to evaluate the relationship between MASLD and bone markers in postmenopausal women.

The study is a cross‐sectional study, carried out in Manmohan Memorial Teaching Hospital, Kathmandu from March 2019 to August 2019. Altogether 105 cases of MASLD and non‐MASLD postmenopausal women were included in this study as case and control respectively. Anthropometric measurements were recorded using a standard checklist. Serum calcium, phosphorus, and alkaline phosphatase were measured, and statistical analysis was done using SPSS version 16. A p value < 0.05 was indicated as statistically significant.

The median age of postmenopausal women did not differ significantly between those with and without MASLD (Non‐MASLD: 60.0 years, IQR 53.0–69.0; MASLD: 58.0 years, IQR 55.0–65.0; p = 0.66). Similarly, systolic and diastolic blood pressures (SBP and DBP) showed no significant differences between the groups. Women with MASLD, however, exhibited higher anthropometric measurements, including body mass index (BMI: 26.4 vs. 20.3 kg/m²) and waist circumference (WC: 96.5 cm vs. 88.9 cm). Biochemically, median serum calcium levels were significantly lower in women with MASLD (8.9 mg/dL, IQR 8.1–9.7), while median serum phosphorus (4.9 mg/dL, IQR 4.3–6.3) and alkaline phosphatase (ALP) levels (197.8 U/L, IQR 166.7–247.5) were significantly higher compared to the non‐MASLD group (p < 0.001).

This study showed significant changes in bone markers (serum calcium, phosphorus, and ALP) in postmenopausal women with MASLD than those without MASLD. Throughout our study, confounding factors such as BMI and waist circumference have significantly influenced the occurrence of bone disorders.