The pathogenesis of hepatic bone disease in patients with CLD is not exactly known; there are multiple factors involved like deficiency of vitamin D and insulin-like growth factor (IGF-1) [17-18], hyperbilirubinemia, and hypogonadism (estrogen and testosterone deficiency), which contribute to bone loss in chronic liver disease. The gene discussed is IGF1; the disease is hyperinsulinemic hypoglycemia, familial, 4.