Simultaneously, chronic hyperinsulinemia and hyperglycemia, common features in MASLD, negatively impact bone metabolism (34), where these metabolic insults impair insulin/IGF-1 signaling to osteoblasts, thereby inhibiting bone formation, and favor adipogenic differentiation within the bone marrow niche at the expense of osteogenesis (67, 68). Here, IGF1 is linked to metabolic dysfunction-associated steatotic liver disease.