When Your Liver Attacks Your Bones. Here’s How To Protect Yourself.

Updated: January 12, 2024

liver and bone health

Authored By:
Lara Pizzorno – AlgaeCal Scientific Advisory Board Member
Best-selling author of Healthy Bones Healthy You! and Your Bones; Editor of Longevity Medicine Review, and Senior Medical Editor for Integrative Medicine Advisors.

1 in 4 Americans has a secret enemy. And it’s hiding inside them. I’m talking about Non-Alcoholic Fatty Liver Disease (NAFLD). And the worst part? This silent disease doesn’t just wreck your liver. It’s bad news for your bones too!

The name may be a mouthful, but NAFLD simply means excess fat is globbing up your liver. And it’s not the result of one too many cocktail parties – it’s happening to non-drinkers too! The silent epidemic is sweeping across America, set to ensnare even more of us in the coming years [1].

So, what’s causing this fatty liver frenzy? And how can we protect ourselves? Well, the first thing we need to do is understand the vital connection between your liver and your bones.

Liver and bone health

How Does Your Liver Impact Bone Health?

Your liver is an incredibly hard-working organ that carries out over 500 different functions vital to your body’s health [2]. Among its myriad duties, your liver impacts several aspects of bone health. These include:

Vitamin D activity

Whether you get your vitamin D from sunlight or take it as a supplement, this nutrient requires two steps of conversion before it can become active. First, it must travel to your liver for its initial conversion, and then it’s sent to your kidneys to become active. When your liver isn’t functioning optimally, vitamin D can’t be converted into a form that’s usable by your kidneys, and you end up missing out on this crucial bone-building nutrient [3]. 

Since vitamin D is essential for calcium absorption, poor liver health directly impacts your bone mineral density.


Your liver is well-known for its detoxification duties. Along with your kidneys, your liver helps relieve the toxic burden your body undergoes each day. And we’re not just talking about the environmental toxins lurking everywhere in our environment, but also the endogenous toxins produced within your body as a result of normal metabolism.

When liver function is suboptimal, toxins build up and create bone-destroying inflammation [4]. 

And to make matters worse, as your body tries to deal with all of the excess toxins it’s accumulating, it starts to shuttle them into your fat cells for safekeeping. This increases the production and size of fat cells, which can lead to issues like insulin resistance and, you guessed it, fatty liver disease [5]. 

This means that in an upsetting feedback loop, poor liver health breeds even worse liver health, and your bones take a hit in the process.

Bone-building proteins

Studies show that NAFLD may directly impact the activity of crucial proteins involved in bone metabolism. Specifically, research shows that blood levels of proteins responsible for bone renewal drop (some examples include osteoprotegerin (OPG), osteocalcin, and insulin-like growth factor) while bone-resorbing activity increases [6].

Bile production

Your liver is responsible for producing bile, which helps your body absorb the fat-soluble vitamins A, D, E, and K

All four of these vitamins play critical roles in bone health, for example:

  • Vitamin D is necessary for the absorption of calcium, which is crucial for healthy bone mineral density [7]. 
  • Vitamin K2 activates the proteins that ferry calcium into our bones and keep it out of soft tissues, like our kidneys, breast, brain, and cardiovascular system [8]. 
  • Vitamin A is needed to balance vitamin D levels and protect against too much calcium absorption. When vitamins A and D are out of balance, it puts us at risk of forming calcium oxalate kidney stones [9].
  • Vitamin E protects our cells from inflammation caused by different types of free radicals. Without this essential antioxidant, our risk of excess osteoclast activity (bone resorbing) greatly increases [10]. 

Therefore, impaired liver function leads to low bile production and potential bone-threatening nutrient deficiencies.

Healthy vs fatty liver

What Causes NAFLD?

Anything that promotes insulin resistance can promote NAFLD. This includes obesity, high blood pressure, high triglyceride levels, low levels of HDL (the “good” cholesterol), or high fasting blood sugar levels [11][12][13]. 

How does insulin resistance promote NAFLD? Well, far beyond its detoxification duties, your liver plays a central role in processing all the nutrients you take in from your diet.

When glucose levels spike after consumption of refined carbohydrates, your liver converts the excess into triglycerides that get stored in fat cells, like those that accumulate in fat around your waist or on your hips and thighs. 

Your liver also converts excess amino acids absorbed from the protein you digest into triglycerides, and these triglycerides are – once again — stored in muscle or fat cells to be converted into glucose for energy when needed. 

Normally, very little fat is stored in the liver. Instead, your liver will try to get rid of the excess fat by sending triglycerides out to fat cells for storage. But when your fat cells fill up, they try to send fat back into circulation – where it goes to the liver. The overload of fat and nutrients running through your liver ultimately produces free radicals, which can cause liver damage. 

Meanwhile, too much fat in your liver is also associated with too much fat in your bone marrow as well as in your muscles. And in fact, some research suggests that NAFLD may be promoted by sarcopenia when your muscle is replaced by fat [14][15]. 

Although non-alcoholic fatty liver disease (NAFLD) is usually associated with obesity, individuals who are not overweight can also develop NAFLD. Sadly, what is now being called “Lean NAFLD” or “non-obese NAFLD,” is growing increasingly prevalent. Risk factors for lean NAFLD include fat weight gain even within normal weight limits, insulin resistance, high refined carbohydrate, fructose and high cholesterol intake, increased gut permeability and an altered microbiome – all of which combine to produce sustained inflammation within the liver. Lifestyle modification, including diet and physical activity are the mainstay in treating non-obese NAFLD [16].

Other potential causes of NAFLD include thyroid disease, excessive intake of refined carbohydrates, particularly the high fructose corn syrup used in processed foods (due to the impact on blood sugar), and a sedentary lifestyle.

Five Ways To Protect Your Bones Against NAFLD

#1 Reduce your toxic burden

The number one thing you can do to support your liver is to reduce your overall toxic burden. This includes toxins found around your home and office, as well as in the food you eat. Toxic insults are everywhere these days – personal care products, water, food, cooking appliances; even our clothes can contain environmental toxins [17][18][19]. 

Your liver will thank you for anything you can do to reduce your toxic burden, but to specifically fend off NAFLD – avoiding sugar is crucial. Particularly high fructose corn syrup (HFCS). 

Unfortunately, our food supply is littered with HFCS, so checking labels when you’re at the grocery store is a must. If you think avoiding the obvious culprits like soda and candy is enough, think again. HFCS can be found in all types of packaged foods, including condiments, dressings, snack foods, and even bread.

#2 Consume adequate protein

Conditions like NAFLD are linked to excess body fat and reduced muscle, and when muscle mass is reduced, it puts you at risk for bone diseases like osteoporosis. Therefore, one way to ensure your bones stay healthy and strong is to maintain a diet rich in protein, especially the muscle-building amino acid leucine.

Some leucine-rich foods include [20]: 

  • Cheese: Gruyere, Emmental, asiago, parmesan, gorgonzola, feta.
  • Fish: tuna, salmon, sardines.
  • Beans: dried peas, fava beans, tempeh, extra firm tofu, lentils.
  • Nuts: pine nuts, almonds, pistachios.

#3 Make movement a priority

Exercise is vital for bone and muscle health for several reasons:

  1. When you exercise, it inhibits a protein called myostatin. Myostatin not only inhibits muscle cell growth and proliferation, but it also recruits osteoclasts to your bones, which are the cells responsible for breaking down bone [21]. 
  2. Exercise increases the release of a hormone-like molecule called ​​Irisin. Irisin lessens insulin resistance, increases your muscles’ use of energy, causes white (inactive) fat to turn into energy-burning brown fat, and triggers the development of osteoblasts (bone-building cells) [22]. 
  3. The contraction of your muscles during exercise stimulates the release of the hormone-like compound Beta-aminoisobutyric acid (BAIBA), which protects bone cells from oxidative stress and death. When bone cells die, it stimulates the recruitment of osteoclasts, so in essence, BAIBA slows the process of bone resorption by protecting against an influx of osteoclast activity [23]. 
  4. Exercise increases the release of bone-building hormones like osteocalcin, which also plays an important role in our ability to secrete and respond to insulin, improving our ability to use energy instead of overloading the liver [24].
  5. And, of course, the mechanical pressure of physical activity on bones assists with bone strength and integrity [25].

#4 Ensure you’re getting enough omega-3 fats

Omega-3 fatty acids reduce triglyceride and very low-density lipoprotein (VLDL) levels and are also essential nutrients for optimal bone health. Getting enough omega-3s can help to ensure your bones are strong and healthy while also reducing risk factors for NAFLD [26][27].

That said, it would be very challenging to get enough omega-3s through diet alone, and not all supplements are created equal. That’s why finding a high-quality omega-3 supplement that contains the most bioavailable form of omega-3s from pure and sustainable sources is crucial.

#5 Enjoy your coffee

Although it gets a bad rap at times, studies show that drinking coffee is associated with a lower risk of developing NAFLD, and it’s also good for your bones.

In fact, a recent meta-analysis found that individuals drinking three or more cups of coffee daily had a 27% lower risk of NAFLD. It’s thought that caffeine reduces oxidative stress and liver inflammation, and other substances in coffee, such as cafestol, kahweol, chlorogenic acid, and ferulic acid, are antioxidants that reduce the accumulation of triglyceride and cholesterol in liver cells [28][29].

How Is NAFLD Diagnosed?

NAFLD is usually diagnosed after an unexplained elevation of liver enzymes is seen in blood labs or when liver cells’ infiltration by fat is seen on imaging (e.g., an abdominal ultrasound) [30][31].

In blood tests, elevations in alanine aminotransferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase, and bilirubin are biochemical markers of liver injury. Bilirubin also indicates the liver’s ability to detoxify metabolites and transport the resulting compounds into bile.

Tests to visualize the appearance of the liver include ultrasound, computed tomographic (CT) scan, and magnetic resonance imaging (MRI).

You may also receive transient elastography, an ultrasound-based test that measures how stiff the liver is. Or you could receive a liver biopsy, in which a small tissue sample is removed from the liver and checked under a microscope for signs of damage or disease.


NAFLD may be on the rise, but that doesn’t mean you have to fall victim. When you know how to prevent insulin resistance and its accompanying conditions, you can get ahead of complications like NAFLD and potential bone loss. 

Incidentally, taking care of your bones and taking care of your liver look very much the same; exercise regularly, eat a whole foods diet, and know how to supplement with high-quality nutrients like omega-3 fatty acids.

To access FREE exercise videos that support your liver and strengthen your bones, join the AlgaeCal Community.


What causes fatty liver disease in nonalcoholics?

The most common causes of fatty liver disease in nonalcoholics are insulin resistance, obesity, diabetes, and dyslipidemia. All of which can be traced back to the improper metabolism of nutrients by the liver.

How is NAFLD diagnosed?

The most common way that NAFLD is diagnosed is through the appearance of elevated liver enzymes, alanine aminotransferase (ALT), and aspartate aminotransferase (AST) in a blood test.

Can liver problems cause osteoporosis?

Yes, when the liver isn’t functioning properly, it can interfere with several bone-related processes, including vitamin D regulation, inflammation, nutrient absorption, and the activity of bone-building proteins.

Can the liver recover from NAFLD?

Yes, one of the most effective ways to turn NAFLD around is through sustained weight loss.



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Article Comments

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  1. Karin

    August 2, 2023 , 8:23 am

    Thank you, Lara!

    I love your articles. Very informative. I’m mostly a plant based eater (wild Alaskan salmon about twice a month). I appreciate it when you cite vegan options.

  2. Patricia A DeSimio

    August 2, 2023 , 8:54 am

    How can you say That coffee is good for your bones when it contains caffeine which depletes Calcium out of your bones.

  3. Manja AlgaeCal

    August 2, 2023 , 11:27 am

    Great question, Patricia! Coffee can increase urinary excretion of calcium, but only by a bit… and this can be offset by taking your coffee with a source of calcium and eating a calcium-rich diet. Coffee recommendations differ based on body weight, but researchers suggest limiting coffee to 3 cups a day. If you’d like to learn more, we have a great article on coffee and bone health here. Let us know if you have any questions!
    – Manja

  4. Sarah Anne Lombardo

    August 2, 2023 , 9:21 am

    interesting that this article never mentions the effects of ETOH on the liver! My research has shown that even small amounts spikes insulin. Not to mention the added sulfates that can add to the toxic overload for liver! I’ve adopted a “Healthy Keto” diet with intermittent fasting and have noticed a profound change in all of my fatty liver! Gone is my numbness and tingling in arms, fingers and toes. Also my brain fog has lifted and I feel less ongoing stress. Gluten free has also helped with gut issues. Thank you for your article!

  5. Manja AlgaeCal

    August 2, 2023 , 12:08 pm

    Thank you for your feedback, Sarah Anne! Those are definitely topics worth mentioning in our next article.
    On another note, I’m really glad to hear you’ve found a diet regimen that works for you and that you’re feeling better! Please don’t hesitate to reach out if you have any questions.
    – Manja

  6. dee fort

    September 6, 2023 , 4:17 am

    they told me for yrs my enzymes were high . i’m at good weight and i eat good . they can’t figure it out .i do take omega 3 every day. and d3 zinc . they did sonograms. looks good . they just said my liver is big for my size body.

  7. Manja AlgaeCal

    September 6, 2023 , 8:58 am

    Sorry to hear that, Dee! I hope you find some of the information in our article helpful. It’s great to know that you are in good health otherwise. Keep up the great work!
    – Manja

  8. Noel Sohn

    September 30, 2023 , 12:07 pm

    I get extra help for prescription, would your product be covered, too expensive for me every month, on a fixed income.

  9. Shelby AlgaeCal

    October 2, 2023 , 9:27 am

    Thank you for your interest in our products, Noel! This is a great question. While we understand that our products can represent a significant investment in your health, they truly work! AlgaeCal is the only calcium supplement clinically supported to increase bone mineral density. That said, as AlgaeCal is a completely natural product, it’s not usually covered by insurance, however, some of our customers have had their supplements successfully covered by asking their doctor to write a prescription. We aren’t aware of the exact details but AlgaeCal may be covered by a flexible savings plan. Please contact your insurance company to determine if that’s an option for you. 🙂
    – Shelby

This article features advice from our industry experts to give you the best possible info through cutting-edge research.

Lara Pizzorno
MDiv, MA, LMT - Best-selling author of Healthy Bones Healthy You! and Your Bones; Editor of Longevity Medicine Review, and Senior Medical Editor for Integrative Medicine Advisors.,
Dr. Liz Lipski
PhD, CNS, FACN, IFMP, BCHN, LDN - Professor and Director of Academic Development, Nutrition programs in Clinical Nutrition at Maryland University of Integrative Health.,
Dr. Loren Fishman
MD, B.Phil.,(oxon.) - Medical Director of Manhattan Physical Medicine & Rehabilitation and Founder of the Yoga Injury Prevention Website.,
Prof. Didier Hans
PHD, MBA - Head of Research & Development Center of Bone Diseases, Lausanne University Hospital CHUV, Switzerland,