In decreased BMD patients (n=52), the postoperative spinal BMD was increased with all three treatment modalities. A more significant increase was found with ALN treatment (+0.103) compared to NO treatment (+0.029) (P-value 0.016). However, femoral BMD decreased despite ALN treatment. Alendronate use was a significant factor for post-LT spinal BMD improvement in the univariate and multivariate analysis. There were significant newly-developed pathologic fractures after LT especially in osteoporotic patients (28%).