EP447 - ECE_1385 - Associations between DXA-derived parameters of body composition and bone mass density in patients with T2DM and metabolic dysfunction-associated steatotic liver disease

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Abstract Introduction Metabolic dysfunction-associated steatotic liver disease (MASLD) appears to be associated with changes in bone mineral density (BMD) and fracture rate; however, the current data are ambiguous. The relationship between MASLD and bone metabolism remains controversial regarding the protective effect of mechanical loading vs the detrimental effects of insulin resistance and chronic inflammation. This study aimed to clarify the effects of MASLD on bone health in the setting of obesity and type 2 diabetes mellitus (T2DM) in a European population. Methods This cross-sectional observational study enrolled 156 patients with T2DM and MASLD (95 females, 61 males; mean age 62.85 ± 10.73 years), compared against a control cohort of 40 T2DM patients without hepatic involvement. Hepatic steatosis was rigorously quantified using vibration-controlled transient elastography (FibroScan®), with a Controlled Attenuation Parameter (CAP) threshold of >238 dB/m. BMD and detailed body composition (fat/lean mass, android/gynoid ratio) were evaluated via DXA. The biochemical profile focused on the GH/IGF-1 axis, insulin resistance (HOMA-IR), and a comprehensive panel of bone turnover markers (BTMs), including Osteocalcin, P1NP, and bCTX. Results Patients with MASLD exhibited significantly higher BMI (Body Mass Index), visceral adiposity, and HOMA-IR compared to controls. In the overall cohort, CAP positively correlated with total BMD (r = 0.21, P = .001). Sex-stratified analysis revealed this association was significant only in females (r = 0.29, P = .004). Conversely, in males, CAP showed a significant negative correlation with BTMs (Osteocalcin: r = −0.35, P = .006; bCTX: r = −0.26, P = .04). Multivariable ROC analysis revealed that traditional BMI-based assessments are suboptimal. The most robust diagnostic performance was achieved in females (Figure 1), where a model integrating CAP, age, and android fat % yielded an AUC of 0.746 (Sensitivity 76.4%, Specificity 71.4%). In the overall cohort, the inclusion of AGR (Android-to-Gynoid fat Ratio) (Figure 2) and ALMI (Appendicular Lean Mass Index) (Figure 3) significantly improved the identification of reduced total BMD and BMD of the hips, respectively. Conclusions In T2DM, the MASLD-bone relationship is sexually dimorphic: while liver steatosis correlates with higher BMD in women via android fat distribution, it impairs bone remodeling in men. Clinical screening for fracture risk in MASLD patients would benefit from evolving beyond BMI to incorporate sex-specific algorithms and DXA-derived soft tissue metrics to optimize diagnostic accuracy.

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