Abstract: Aim of this study to detect the effect of chronic liver diseases on bone mineral density and bone turnover markers. Sixty two patients with chronic hepatitis C viral (HCV) infection were included in the study. They were 37 males and 25 females, their ages ranged from 27 to 68 years. They were divided into two groups. The first group consisted of 37 patients with chronic hepatitis (22 males and 15 females, age range: 27-59 years) and the second group consisted of 25 patients with liver cirrhosis (16 males and 9 females, age range: 34-68 years). Thirty three healthy subjects age and sex matched with the patients were taken as control group. For all patients and controls Bone Mineral Density (BMD) g cm¯2 of the lumbar spines and the left proximal femur were measured by dual energy X-ray absorptiometry (DEXA) and serum levels of osteocalcin, C- terminal propeptide of type I collagen (CICP), osteoprotegrin (OPG) and soluble receptor activator of nuclear factor (sRANKL) NF-KB ligand and urinary deoxypyridinoline (DPD) were assessed. The results showed that BMD at the proximal femur was normal among 35.1% of patients with chronic hepatitis, 36% of patients with liver cirhosis and 51.5% of controls with insignificant difference. Osteopenia was present among 43.2% of patients with chronic hepatitis, 32% of patients with liver cirrhosis and 39.4% of controls with insignificant difference. Osteoporosis was significantly more prevalent among patients with liver cirrhosis (323%) compared to controls (9.1%) p = 0.04. BMD of the lumbar spine was normal among 45.9% of patients with chronic hepatitis, 48% of patients with liver cirrhosis and 72.7% of normal control with insignificant difference. Osteopenia was present among 45.9% of patients with chronic hepatitis, 36% of patients with liver cirrhosis and 24.2% of controls with significant difference between chronic hepatitis and controls (p = 0.02). Osteoporosis was present among 8.1% of patients with chronic hepatitis, 16% of patients with liver cirrhosis and 3% of controls with insignificant difference. There was no significant difference as regard mean values of osteocalcin and CICP between chronic hepatitis (7.6±13.1 and 171.9±136.3, respectively), cirrhosis (7.3±3.7 and 246.5±160.2, respectively) and controls (3.4±3 and 224.2±122.1, respectively). Mean values of OPG were significantly higher in cirrhosis (8.9±9.1) compared to controls (4.9±3.9) (p = 0.03). As regard markers of bone resorption, there was no significant difference between the three groups. Mean urinary DPD levels among chronic hepatitis, cirrhosis and controls were: 40.3±29.8, 42.2±26.7 and 65.7±49.6, respectively. Serum levels of sRANKL among chronic hepatitis, cirrhosis and controls were: 0.5±0.5, 0.6±0.7 and 0.4±0.3, respectively. When we classify all patients and controls according to BMD of proximal femur and lumbar spine, into three groups: normal, osteopenia and osteoporosis, we did not found any significant difference as regard bone turnover markers between the three groups. When we do the same classsification for the patients with chronic hepatitis and cirrhosis each separately, we found that in patients with cirrhosis, mean CICP levels were significantly lower among patients with osteopenia of proximal femur (172±108.1) compared to patients with normal BMD (351.6±131.8) (p = 0.05). BMD is decreased in chronic liver disease, with the proximal femur most commonly affected and patients with liver cirrhosis are at higher risk than patients with chronic hepatitis.