When secretion of bile and bile salts is insufficient, i.e., bile salts drop below the critical micellar level in the duodenum, malabsorption of both fat and fat-soluble vitamins may ensue. Serum levels of vitamin A and E have been shown to be low in a minority of patients with primary biliary cirrhosis prior to development of jaundice [72] . Osteomalacia is barely seen in PBC, as a liver transplant is performed in most patients before the development of this complication of prolonged deep jaundice.