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A recent meta-analysis in 364 LT patients from six randomized controlled trials have found that bisphosphonate therapy improved lumbar spine BMD by 0.03?g/cm2 (95% CI 0.01�C0.05?g/cm2, P?=?0.02) at 12?months post-LT compared with the control group. However, a statistically significant change in femoral neck BMD could not be demonstrated in this meta-analysis. Data on fractures could not be analysed [21]. In our study, ��-CTX decreased as from 3?months in both groups and persisted throughout follow-up, reflecting a reduction of bone resorption after transplantation. Good adherence to oral RSN treatment in LT patients ensures adequate inhibition of bone resorption. Greater reductions in ��-CTX may be obtained with intravenous bisphosphonates. Shane et?al., showed a significant decrease in urinary deoxypyridinoline in heart transplant http://www.selleckchem.com/products/Everolimus(RAD001).html recipients after intravenous pamidronate treatment [22]. Misof et?al., described a significant decrease in ��-CTX levels 6?months after LT in 13 patients treated with intravenous zoledronic acid [23]. Procollagen type 1 amino-terminal peptide levels significantly increased in CON group at 6?months, but did not change in RIS patients. Other groups have previously reported an increase in bone turnover markers such as osteocalcin after LT [7,24]. As in our study, that increase seems to be attenuated in patients who have been treated with bisphosphonates such as zoledronate http://www.selleckchem.com/products/PD-0332991.html [23] or pamidronate [25]. Inadequate levels of vitamin D have been described in patients with end-stage liver diseases prior to LT and this may play a role in the aetiology of lower mineralization after transplantation. At baseline, 91% of patients had insufficient serum levels of 25(OH)D and after adequate supplementation, both groups increased serum 25(OH)D levels from 3?months onwards. Crosbie et?al. [26] found correlation between serum 25(OH)D levels at 3?months and BMD increase at 6?months, suggesting that this vitamin has a positive effect on mineralization. In our study, serum 25(OH)D levels showed positive correlation with the percentage change in total hip and femoral neck BMD at 12?months of treatment. These results and the fact that we could not demonstrate significant differences between RSN and CON group suggest that vitamin D could have a main role in bone loss prevention http://www.selleck.cn/products/Bortezomib.html after LT. Our study has several limitations. The most important one is that sample size was calculated to detect 3% points in the change from baseline to 12?months in BMD between groups. We found differences of 1.47% in lumbar BMD spine and 2.11% in femoral neck BMD between groups. With this information, we conclude that the true difference was probably