Multiple factors, such as vitamin D deficiency, low levels of osteocalcin, PTH, insulin growth factor-1(IGF-1), hypogonadism, behavioral factors such as low body mass index (BMI), malnutrition [35], and a sedentary lifestyle with physical inactivity [36] are frequently observed in these patients, especially those with cirrhosis. Here, IGF1 is linked to hypogonadism.