Current evidence robustly supports several key points: insulin resistance, chronic inflammation, and other shared mechanisms underpin the co-occurrence of MASLD, sarcopenia, and osteoporosis; epidemiologic studies consistently show greater muscle and bone loss in individuals with MASLD; and the presence of osteosarcopenia is associated with adverse outcomes including frailty, fractures, and increased mortality. Here, INS is linked to metabolic dysfunction-associated steatotic liver disease.