Several recent studies have supported the association between low BMD and alcoholic or nonalcoholic fatty liver disease, confirming a low negative correlation between liver fat content and lumbar BMD in middle-aged and elderly people [41, 42], and fatty liver and BMD may be linked by IGF-1, OPG, OCN, inflammatory cytokines and other factors [43]. The gene discussed is TNFRSF11B; the disease is metabolic dysfunction-associated steatotic liver disease.