Chronic liver disease and liver transplantation may cause hepatic osteodystrophy due to many risk factors, e.g. malnutrition, immobility, hypogonadism and immunosupressants. Reduced bone formation and increased resorption contribute to osteoporosis and fractures after liver transplantation. The aim of this study was to investigate bone metabolism after liver transplantation. Patients and methods – Bone markers were measured in in 35 liver transplant recipients (32-59 years) on day 0 and 14, 3 months and 6 months after surgery. DEXA (L1-L4, left hip) was performed at 6 months in 20 patients. Bone markers measured: osteocalcin (OC), procollagen 1 propeptide (P1CP), beta crosslaps (CS), bone alkaline phosphatase (BAP) and osteoprotegerin (OPG). Immunosupressive therapy included corticosteroids, tacrolimus and mycophenolat mofetil. Results – Initially CS was high, BAP and P1CP were moderately increased, and OC decreased. BAP and OC increased significantly (paired Wilcoxon test) in the follow-up period, alhtough OC remained low. P1CP normalised in the first three months and CS after 6 months, both changes were significant. Osteoprotegerin decreased by half after 14 days (p<0.01) and remained during this period. Osteoporosis of both sites was found in 3 (M), osteopenia in 8 (5M, 3 F) and osteopenia of hip only in 2 patients (1M, 1F). No differences between sexes for bone markers or densitometry T-scores were found. These results indicate disorder of bone turnover after liver transplantation. Bone resorption was increased and also OPG . Differences were observed for bone formation markers, BAP and P1CP were moderately or initially increased, but OC was decreased. This finding can not be explained by differences in clearance routes of bone formation markers. Conclusions - Increased bone resorption normalised within 6 months after liver transplantation. Bone formation markers did not unequivocally indicate decreased, increased or normal osteoblast activity, and it remains to be further investigated. Bone turnover imbalance together with high incidence of osteoporosis and osteopenia (11/20) after liver transplantation points to skeletal impairment.