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Introduction Patients with cirrhosis are at increased risk of fractures.UK National Osteoporosis Guideline Group (NOGG) recommends use of FRAX score to quantify fracture risk in this high-risk group and to manage accordingly.Methods Prospective data was collected for patients admitted with decompensated cirrhosis between March and November 2025 in two hospitals delivering level 1 and level 2 hepatology care. Inpatient FRAX score was calculated using data from patient notes and electronic health record.Results During the study period 101 individuals were admitted. The most common aetiology was alcohol-related cirrhosis (75%). Male to female patient ratio was 1.5:1 and mean age at presentation was 61 years (range: 40-88). Based on FRAX score, majority of patients were intermediate-risk (53%) followed by low-risk (32%). Twenty-seven patients had their vitamin D levels checked during admission with average of 35.2. Twelve patients (44%) had levels in deficient range (<25 nmol/L) while 10 patients (37%) had inadequate levels (26-50nmol/L). Twenty-two individuals were eligible for bisphosphonates treatment (high-risk and intermediate risk above treatment line). Of these individuals, fifty percent (11/22) had high-risk endoscopic findings and were not suitable for oral bisphosphonates therapy. Four of these patients were treated with a single dose of intravenous (IV) risedronate prior to discharge. Two patients (out of total 5) who were on oral bisphosphonates had previous high-grade varices on endoscopy.Conclusions Osteoporotic fracture can be a devastating complication of cirrhosis. In this study we found 44% of individuals were vitamin D deficient and 20% were at significant risk of fracture warranting bisphosphonate therapy. Single IV dose bisphosphonate appears to be a reasonable intervention in this high-risk group. An inpatient bone protection pathway was thus formulated to risk stratify and treat patients (as per NOGG recommendations) as an A6 sticker ( figure 1) to fit within paper notes.Abstract P110 Figure 1