Effect of Fatty Liver Disease on Bone Density

All included patients will be subjected to the following: 1. Complete history taking including age, sex, current medical history (e.g. hypertension, diabetes mellitus, cardiovascular disease, renal, thyroid, parathyroid diseases and menopausal status), daily alcohol consumption and smoking status will be recorded from interviews with the participants during the examination. 2. thorough clinical examination. The participants' anthropometric measurements will be obtained including: their body weight, height, waist circumference (WC) and body mass index (BMI). General examination Arterial blood pressure will be recorded and for detection of stigmata of chronic liver disease. Abdominal examination will be done for assessment of the size of the liver and spleen. 3. Diagnosis of NAFLD: The diagnosis will be based on abdominal ultrasound findings and will be confirmed by fibroscan examination as the following: 1. Abdominal ultrasound: steatosis will be graded according to Quinn and Gosink (1985) as the following: Grade I: Minimal diffuse increase in the fine echoes. Liver appears bright compared to the cortex of the kidney. Grade II: Moderate diffuse increase in the fine echoes. Slightly impaired visualization of the intrahepatic vessels and diaphragm. Grade III: Marked increase in the fine echoes. Poor or no visualization of intrahepatic vessels and diaphragm and poor penetration of the posterior segment of the right lobe of the liver 2. Fibosscan to evaluate steatosis grades by CAP score and fibrosis stages as described by (Sasso et al., 2010). 4. Laboratory investigations: 1. Complete Blood Count (CBC). 2. Liver profile: alanine aminotransferase (ALT), aspartate aminotransferase (AST), serum albumin, total and direct bilirubin, prothrombin time and INR. 3. Renal profile: creatinine and urine analysis. 4. Total cholesterol, triglyceride (TG), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C). 5. Fasting blood sugar. 6. (HBsAg, HCV Ab) Viral markers. 7. 25-hydroxyl-vitamin D (25(OH)D) in serum. 8. Serum Osteocalcin as a marker of bone formation and serum NTX as a marker of bone resorption.