Associations between DXA-derived parameters of body composition and bone mass density in patients with T2DM and metabolic dysfunction-associated steatotic liver disease: a cross-sectional study

Background Metabolic dysfunction-associated steatotic liver disease(MASLD) is associated with the deterioration of bone mass density(BMD), but the independent contributions of soft tissue parameters of body composition are not fully understood. We aimed to evaluate the relationship between the degree of liver steatosis, as assessed by vibration-controlled transient elastography(FibroScan®), and DXA-derived BMD indices in the European population. Methods 156 patients, 95 females and 61 males, aged 33–78 years, treated for T2DM and MASLD with oral antidiabetic medication, were included in this cross-sectional study. Subgroup analyses were conducted by sex, age, BMI, lean mass index, and the extent of fibrosis. Multiple linear regression models were fitted with BMD indices as the dependent variable and the Controlled Attenuation Parameter(CAP) as a measure of liver steatosis, serving as the independent variable. The models were adjusted for age, sex, HOMA-IR, BMI, lean mass index, and android fat mass%. Accordingly, ROC curves with T-score(Z-score)=-1.0 were plotted as a classifier of bone mass deterioration. Results The total BMD and CAP were positively correlated in the entire group(r = 0.21,p = 0.001) and in the female group(r = 0.29,p = 0.004), but not in the male group(r = 0.08,p = 0.51). The association maintained significance after adjustment for total body fat%(r = 0.23,p = 0.003), AGR(r = 0.22,p = 0.005), lean mass index(r = 0.19,p = 0.02) and osteocalcin(r = 0.16,p = 0.04) but not for BMI(r = 0.13,p = 0.09). The AUC in the female group for total BMD in the model calculated from CAP and android fat mass% and adjusted for age, was: ROC = 0.746(95%CI 0.62–0.88). Conclusions Our results demonstrate existing discrepancies in the association between BMD and MASLD across sex-, age-, BMI-, lean mass index-, and fibrosis-stratified analyses. CAP and android fat% may have clinical value in predicting osteopenia in patients with MASLD and T2DM. Clinical trial number Not applicable.