The physiopathology, diagnosis and treatment of hepatic osteodystrophy are discussed in this review. Hepatic osteodystrophy (HO) is a generic definition for the metabolic bone disease that may occur in individuals with chronic liver disease. Two distinct bone metabolic processes, osteoporosis (OP) and osteomalacia (OM) are combined together in various proportions in HO syndromes. The relative importance of these two diseases in a given case is quite variable. HO is a common complication among individuals with long time lasting hepatic disease, particularly those with cholestasis. Since advanced HO is difficult to treat and adversely affects both the quality of life and the long-term prognosis of patients with chronic liver disease, special care is required in order to prevent the development of clinical bone disease in individuals with advanced hepatic disease.