Independent of the etiology, bone mineral loss is a recognized complication of cholestatic liver diseases. In PBC, it moderately increases absolute and relative fracture risk compared to the general population [315, 316] . Treatment of the underlying liver disease with UDCA does not prevent bone loss in PBC [317, 318] . Calcium and vitamin D supplementation is usually recommended in osteoporosis, although their role in preventing osteoporosis and fracture in chronic liver disease is unclear [319, 320] . Alternative interventions to prevent and treat osteoporosis in liver disease have only been tested in a few studies.