AI Summary Low bone mineral density occurred in 52.3 per 100 person-years among people with fatty liver disease (MASLD), compared with 32.7 per 100 person-years among people without it.
Medically reviewed.
Liver disease can reach beyond the liver and weaken your bones. The liver helps build bone, balance vitamin D and calcium, and make proteins that bones need. When it is damaged, bone density can drop, leading to osteoporosis and a higher risk of fractures. Joint pain can also be linked to liver disease, including iron overload from hemochromatosis. If you have cirrhosis, a cholestatic liver disease, or a liver transplant, ask your care team about bone health.
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About the Connection
The liver does hundreds of jobs. Among them are storing and making proteins, regulating nutrients, and helping structure muscle and bone. When liver disease disrupts these jobs, the damage can extend well beyond the liver.
Disrupted metabolism and vitamin and mineral shortfalls are common in liver disease. Most people with liver disease have a vitamin D and calcium imbalance. Both nutrients are essential for strong bones. Vitamin D helps your body absorb calcium, so a shortage can lower bone density and lead to osteoporosis.
A damaged liver also makes fewer of the proteins bones rely on, such as IGF-I and fibronectin. One study followed people over time and found low bone mineral density in 32.7 per 100 person-years among those without metabolic dysfunction-associated steatotic liver disease (MASLD, also called fatty liver disease). Among those with MASLD, it rose to 52.3 per 100 person-years.
Doctors use the term hepatic osteodystrophy for bone disease linked to liver damage. It includes osteoporosis, which is loss of bone mass, and osteomalacia, which is poor bone mineralization.
Know Your Risk
Bone and joint problems often develop alongside liver disease. Knowing the risk factors and signs helps you raise the issue early with your care team.
Common Conditions
Several bone and joint conditions can occur with liver disease. They often overlap.
Bone loss often causes no symptoms until a bone breaks. Screening and early action can help protect your bones before that happens.
Special Situations
In cholestatic liver diseases, such as primary biliary cholangitis (PBC) and primary sclerosing cholangitis (PSC), bile flow is reduced. Cholestasis makes osteoporosis more likely. Care teams may recommend calcium and vitamin D and follow bone density over time. In PBC, bone density testing is part of regular follow-up, especially when the disease is more severe.
Osteoporosis is a known side effect of long-term immunosuppression, especially with corticosteroids. Adult transplant recipients should have regular bone density screening. In children, corticosteroids are stopped as soon as it is safe, partly because of their effect on bone density. Never stop a prescribed medicine without talking to your transplant team.
Liver damage, nutrition, and some treatments can each weaken bones, and they often act together.
Treating the liver disease, correcting nutrient shortfalls, and staying active together give you the best chance of protecting your bones.
Taking Action
If you have cirrhosis, a cholestatic liver disease, or a transplant, your doctor may order a bone density scan called DEXA. People who already have bone loss are checked yearly. Others are usually checked every 2 to 3 years.
Liver disease often causes shortfalls in vitamins A, B, C, D, and E. A simple blood test can show whether you are low. If you are, your doctor may suggest diet changes or supplements. Ask before starting any supplement.
Weight training strengthens bones, and yoga is gentler on the body while building bone and muscle strength. Aim for about 150 minutes of exercise a week, using low-impact options such as walking, chair yoga, or Pilates if needed. Talk with your doctor before starting a new routine.
Osteoporosis can be treated. In PBC, for example, doctors may consider bone-strengthening medicines based on bone density results, and they avoid some of them in people with varices or significant reflux. Ask your doctor what fits your situation, and never start or stop a medicine on your own.
For sore joints, wear supportive, cushioned shoes and use a cane or walking poles if you need them. A short morning routine of gentle stretches can loosen stiff joints.
Diet and Bone Health
Vitamin D helps your body absorb calcium, and calcium is essential for strong bones. Liver disease often lowers both, and low vitamin D can make osteoporosis worse. What you eat matters.
Vitamins and minerals come from more than fruits and vegetables. If you cannot reach the amounts you need through food, your doctor can recommend supplements.
Foods to Build Your Plate Around
Common Questions
Yes. Liver disease can weaken bones. The liver helps regulate nutrients, and most people with liver disease have a vitamin D and calcium imbalance. Both are essential for bone health. A damaged liver also makes fewer of the proteins bones need, such as IGF-I and fibronectin. Over time, these changes can lower bone density and lead to osteoporosis, which makes bones more likely to break.
Hepatic osteodystrophy is the term doctors use for bone disease linked to liver damage. It includes osteoporosis, which is loss of bone mass, and osteomalacia, which is poor mineralization of the bone. Both leave bones weaker. Doctors recommend checking bone density in all people with cirrhosis, especially those with cholestatic liver disease or those being evaluated for a transplant.
Often no. Bone loss usually causes no symptoms until a bone breaks, so you can have it without knowing. Some people notice bone pain, which can come from vitamin and mineral deficiencies, or joint pain. Because symptoms may not appear early, bone density testing matters for people with cirrhosis, cholestatic liver disease, or a transplant.
Doctors usually use a bone density scan called DEXA. It is recommended for all people with cirrhosis, especially those with cholestatic disease or those being evaluated for transplant. People who already have bone loss are typically checked every year, and others every 2 to 3 years. Your doctor may also order a simple blood test to check your vitamin and mineral levels.
Yes. Joint pain can be linked to liver disease. One example is hemochromatosis, a genetic condition in which iron builds up in the body. Joint pain is its most commonly reported symptom, and untreated iron overload can lead to joint damage and arthritis. Tell your doctor about any new joint pain so the cause can be found. Early detection of hemochromatosis helps prevent more serious problems.
Yes, they can. Long-term immunosuppression after a transplant, especially with corticosteroids, can cause osteoporosis. Transplant recipients should have regular bone density screening. Many people can stop corticosteroids within several months after transplant, while others need long-term low-dose treatment. Never stop these medicines suddenly or without your transplant team's guidance.
Several steps can help. Ask your doctor to check your vitamin and mineral levels, and eat foods that supply vitamin D and calcium, such as tuna, salmon, egg yolks, fortified milk, soybeans, and nuts. Stay active with weight training, yoga, or walking, aiming for about 150 minutes a week if your doctor agrees. Ask your care team about treatment for osteoporosis if you have it.
Medical disclaimer: LiverDirectory provides educational information and a directory of providers. It does not provide medical advice, diagnosis, or treatment. Always consult a licensed physician regarding any medical condition.
