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Reply to Letter to the Editor (HEP-19-1638).

Osteodystrophy is a worrisome complication in chronic liver diseases (CLD), especially in autoimmune liver diseases such as primary biliary cholangitis and autoimmune hepatitis accompanying vitamin D malabsorption and use of corticosteroid. As physical activity is closely associated with bone health (2) , physical inactivity in CLD is likely to worsen bone metabolism. We think that regular exercise should be recommended in patients receiving denosumab treatment.