A Study to Evaluate Efficacy and Safety of Denosumab for Prevention and Treatment of Osteoporosis in 1st Time Liver Transplant Recipients.

Inclusion Criteria: * Age \>=18 years old * First-time Liver transplant Recipients * All men, postmenopausal women and women with history of hysterectomy or tubal ligation * Patients who have not been treated with medications for Osteoporosis within the past 12 months before the liver transplant * Patients able and agreeable to follow up at out Institution for the duration of the study * Patients hospitalized for less than 45 consecutive days after the liver transplant surgery * Patients with GFR\>30ml/min (calculated by Cockcroft-Gault equation, see Table 3 for details) * Patients with corrected Calcium \>= 8.5 * Patients with PTH intact levels WNL (as per lab values) * Patients with vit D\>=20; NOTE: patients with vit D \<20 will be treated with high dose Ergocalciferol 50,000 units daily and rechecked in 2 weeks * Patients with t-score \>=-3.5 at all sites checked by DEXA scan * Patients agree to sign an informed consent form to be in the study * Can be treated with denosumab or placebo within 3 months from the liver transplant date Exclusion Criteria: * Patients with previous transplants * Patients that are getting 2 simultaneous transplants, like combined kidney and liver transplants * Age \< 18 year old * Patients hospitalized for over 45 days after the liver transplant surgery * Patients with GFR\< 30ml/min * Patients with hypocalcemia defined as corrected calcium \< 8.5 * Patients with extensive dental problems, previous hx of Osteonecrosis of the jaw (ONJ) and/or high risk for developing ONJ * Patients with current Hyperthyroidism * Patients with current Primary Hyperparathyroidism defined by the combination of elevated calcium and PTH intact levels * Patients with severe Osteoporosis as defined by t-score \<-3.5 at any site shown by DEXA scan * Women of reproductive age without history of tubal ligation or hysterectomy * Patients who cannot read or understand the Informed Consent Document or study instructions * Patients with diagnosis of dementia, or otherwise unable to give informed consent * Patients unable to follow up in our Institution for the duration of the study