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. This evidence concerns the gene IGF1 and congenital secretory chloride diarrhea 1.