We have studied bone turnover markers and bone mineral density (BMD) in 82 patients (26 females and 56 males) that underwent orthotopic liver transplantation in our center. Follow-up was for a median of 19.2 months (range 1-60 months). During this period they were treated with prednisone, azathioprine and cyclosporine in accordance with protocols. Spinal bone loss was measured with a dual energy X-ray densitometer (precision 1.3%), and, depending on Z score and BMD values, two groups were distinguished: A) Without osteoporosis: 47 patients, Z = -0.98 +/- 0.09 and BMD 0.899 +/- 0.098 g/cm2, and B) With osteoporosis: 35 patients, Z = -2.71 +/- 0.55 and BMD 0.739 +/- 0.080 g/cm2 (X +/- SD). Serum bone markers such as osteocalcin (BGP) 10.0 +/- 0.8 ng/ml and procollagen-I (pColl-I) 268.1 +/- 32.1 micrograms/ml, were found to be increased. Serum PTH was within the normal range. No significant differences were found between the etiologic subgroups studied with respect to bone loss. Also, no correlation was found between bone loss and duration of follow-up or other factors, such as immunosuppressant drugs or acute rejection. Our study confirms an increased prevalence of bone loss in patients with liver transplantation, which is associated with a high bone turnover, indicating that earlier diagnosis and treatment is necessary to improve survival and quality of life in these patients.