1.0 BACKGROUND AND SCOPE OF GUIDELINES

An important complication of chronic liver disease is osteo-dystrophy which includes osteoporosis and the much rarer osteomalacia. Both conditions are associated with significant morbidity through fractures resulting in pain, deformity, and immobility. There is also a further significant increase in the risk of fractures following liver transplantation for end stage chronic liver disease. Osteoporosis is defined as a “progressive systemic skeletal disease characterised by low bone mass and microarchitec-tural deterioration of bone tissue, with a consequent increase in bone fragility and susceptibility to fracture ” (World Health Organisation, 1994). Common fractures are vertebral com-pression fractures, fractures of the distal radius, and proximal femur. Although guidelines on the prevention and management o