Jane Collier – 20 September 2007 – Osteomalacia rarely occurs in adult patients with chronic liver disease despite a low serum vitamin D level being reported in up to two‐thirds of patients with cirrhosis. In contrast, osteoporosis, which increases the risk of vertebral fractures, occurs in 12%‐55% of patients with cirrhosis. Although the prevalence is probably falling, as shown by a fall from 57%‐26% in patients with biliary disease requiring liver transplantation over the last 2 decades, it still accounts for significant patient morbidity.