Fatty liver disease may increase hip and humerus fracture risk in men, cohort study suggests
Presenter: Yonghwan Kim, MD, CHA Bundang Medical Center, Seongnam-si, Gyeonggi-do, Republic of Korea
Association between metabolic dysfunction-associated steatotic liver disease and osteoporotic fracture risk in Korean adults: a nationwide cohort study. Presented April 23, 2026.
Metabolic dysfunction-associated steatotic liver disease (MASLD) was independently associated with an increased risk of hip and humerus fractures in men over 50 years of age in a nationwide cohort study presented at the 2026 AACE meeting.
The findings indicate a possible sex-specific vulnerability in this common condition, study authors said in a poster presentation of their results.
Although not conclusive based on the current observational study, they said, the findings nevertheless highlight the need for targeted preventive strategies and fracture risk assessment in male patients with MASLD.
“I do not think our data justify universal fracture screening solely on the basis of MASLD,” author Yonghwan Kim, MD said in an interview, “but they do support a more targeted and multidisciplinary approach—paying attention to bone health, muscle function, and fall prevention in male patients with MASLD who appear clinically vulnerable.”
Other recent studies have also suggested that osteoporosis and bone fractures may manifest differently in men and women with MASLD, although the underlying reasons remain unclear, Dr. Kim said.
Nationwide cohort analysis
In the current retrospective cohort study, Dr. Kim and coauthors evaluated data on 210,755 adults aged 50 or older who had participated in Korea's national health screening program between 2009 and 2012.
Patients were stratified into MASLD and non-MASLD groups. The outcomes of interest included vertebral, hip, humerus, and distal radius osteoporotic fractures, both overall and individually.
Men with MASLD had a significantly elevated risk of specific fractures—namely, hip and humerus—compared with men without MASLD, according to the study results. By contrast, no significant site-specific associations were observed among women with or without MASLD.
For men with MASLD, the hazard ratio for hip fracture was 1.43, with a 95% confidence interval of 1.02 to 1.99, according to the report. For humerus fracture, the hazard ratio was 1.52 with a 95% confidence interval of 1.03 to 2.26.
Overall fracture risk assessment may be insufficient
Overall, there was no association between MASLD and major osteoporotic fracture risk overall in either sex, the data further show.
During 10 years of follow-up, the cumulative incidence of major osteoporotic fractures among men was significantly lower, at 3.4% in the MASLD cohort vs 4.0% in the non-MASLD cohort (P < .001). Among women, the cumulative incidence was significantly higher, at 9.8%, for the MASLD cohort vs 8.5% for the non-MASLD cohort (P = .0046).
However, no significant differences in overall osteoporotic fracture risk were evident following full adjustment in the Cox regression model, investigators reported.
“The significantly higher risk of hip and humerus fractures suggests that certain patients may have a clinically meaningful vulnerability that would be missed if we only looked at aggregate fracture outcomes,” Dr. Kim said in the interview.
Mechanisms and clinical implications
Mechanisms behind sex-specific differences in fracture risk remain elusive and unanswerable with the current data set. However, Dr. Kim said that elevated fracture risks in the male MASLD group could possibly be due to some combination of impaired bone quality and increased fracture risk.
“Chronic inflammation, insulin resistance, sarcopenia, and possible lack of estrogen-related protection may help explain why the signal appeared particularly for hip and humerus fractures in men,” Dr. Kim said.
“The take-home message is that clinicians should not look at MASLD only through a liver lens. In men with MASLD, especially older or frail patients, multiple aspects such as bone health, muscle function, and fall risk should also be considered.”
Disclosures:
The authors declared no conflicts of interest.
Reference:
Kim Y, Kang H-T. Association between metabolic dysfunction-associated steatotic liver disease and osteoporotic fracture risk in Korean adults: a nationwide cohort study. Endocr Pract 2026; 32(4):S367.