Association between Serum Osteocalcin Levels and Non-Alcoholic Fatty Liver Disease in Women

Background and Aims: Osteocalcin was found to have a significant role in insulin resistance. Insulin resistance is considered a pathophysiological mechanism of nonalcoholic fatty liver disease (NAFLD). However, the relationship between serum osteocalcin level and NAFLD is not well known. Methods: A total of 7,067 women undergoing abdominal ultrasonography, bone mineral density, and serum osteocalcin level measurement were analyzed. Results: Serum osteocalcin level was independently associated with menopausal status, bone mineral density, calcium, phosphate, alkaline phosphatase, fasting blood glucose, triglyceride, low-density lipoprotein cholesterol, alanine aminotransferase, γ-glutamyltransferase, and NAFLD. When women were grouped according to their menopausal status and bone mineral density, the serum osteocalcin level showed an independent inverse association with NAFLD in premenopausal women without osteopenia or osteoporosis (n = 2,941) [odd ratio (OR): 0.94, 95% confidence interval (CI): 0.91-0.96, p < 0.001] and postmenopausal women without osteopenia or osteoporosis (n = 2,155) (OR: 0.96, 95% CI: 0.95-0.98, p < 0.001), however, not in premenopausal (n = 308) or postmenopausal women (n = 1,663) with osteopenia or osteoporosis. Conclusions: The serum osteocalcin level was an independent factor associated with NAFLD, especially for women with normal bone mineral density.