Abstract: Osteoporosis is a common skeletal complication in patients with liver cirrhosis. Osteoporosis is
usually asymptomatic and can result in fractures and impaired quality of life if untreated in time. We review
the diagnosis, pathophysiology and management of osteoporosis in cirrhosis. Osteoporosis is diagnosed based
on the bone mineral density (BMD) assessment using dual-energy X-ray absorptiometry scan. The etiology
of hepatic osteoporosis is multifactorial, including decreased level of insulin growth factor-1, cytokines,
deficiency of vitamin D and calcium, receptor activation of nuclear factor-κB (RANK), the receptor of
nuclear factor-κB ligand (RANKL) and osteoprotegerin (OPG), hyperbilirubinemia, the use of corticosteroid,
hypogonadism, deficiency of vitamin K and genetic polymorphisms. Vitamin D and calcium supplementation
is recommended for all patients with osteoporosis. Specific agents used for treatment of osteoporosis include
bisphosphonates, calcitonin, hormonal therapy and liver transplantation if necessary. Bisphosphonates has
become the mainstay of therapy for osteoporosis prevention and treatment. Measurement of BMD should be
considered in all patients with liver cirrhosis, especially cholestasis cirrhosis, every year.