NR1H4 and metabolic dysfunction-associated steatotic liver disease: OCA is the first FXR ligand to advance to the clinical stage.57 Currently, OCA is being investigated for its potential therapeutic applications in NASH and PBC.58 Interestingly, accumulating experimental evidence suggests a pathophysiological link between NAFLD and osteoporosis.59 Furthermore, the prevalence of osteoporosis in PBC patients is strikingly high, reaching up to 30%.