Background. The aim of this study is to determine the relationship between immunosuppression, disease state, and osteoporosis in an outpatient liver transplant clinic. Methods. All liver transplant recipients visiting an outpatient transplant clinic received bone density scanning with a dual-energy X-ray absorptiometry (DEXA) device of the calcaneal bone after completing a questionnaire assessing risk and medications currently being used. Results. Of the 137 liver transplant (OLT) recipients completing questionnaires and receiving DEXA screening, patients with low bone density (n = 50) were older (56.6 ± 12.7 years vs 50.2 ± 10.1 years; P =. 02) compared with normal density patients (n = 87) and were predominantely female (64.0% vs 35.6%; P =. 01). Based on disease state, patients with cholestatic liver failure had lower bone calcaneal area (17.3 ± 1.3 cm 2 vs 18.9 ± 1.57 cm 2; P <. 01). Patients taking tacrolimus (n = 112), as compared with cyclosporine (n = 25), had a tendency toward fewer findings of low bone density (37.5% [42 of 112] vs 56.0% [14 of 25]; P =. 08) but had more risk factors (3.1 ± 1.2 vs 2.1 ± 0.8; P =. 001) and a higher prednisone dose (4.4 ± 5.9 mg/d vs 2.1 ± 3.8 mg/d; P =. 026). For patients weaned from prednisone, the tacrolimus patients were less likely to have low bone density (36.2% vs 68.8%; P =. 02). Mycophenolate mofetil did not influence bone density or area measured. Conclusions. After liver transplantation, patients taking cyclosporine were more likely to have low bone density compared with those taking tacrolimus. © 2005 by Elsevier Inc. All rights reserved.