Abstract: Objective To investigate the changes of bone mineral density, bone metabolism and risk factors in chronic hepatitis B patients with osteoporosis. Methods From June 2017 to Jan 2019, two hundred chronic hepatitis B patients in Wenzhou people's hospital who had been tested by bone mineral density and bone metabolism indicators were divided into two groups according with or without osteoporosis. The patients who diagnosed osteoporosis were belong to the research group, while the patients without osteoporosis were belong to the control group. Each group has one hundred cases. The age, sex, body mass index, lifestyle(history of tobacco and alcohol, diet and activity), liver function, history of liver disease, long term of using anti-hepatitis drugs and corticosteroids, history of fragility fractures, liver disease and osteoporosis history were observed in the two groups. The relationship between osteoporosis index and the above indicators were analyzed. Results The ratio of female(76% vs. 54%), ≥ 60 years old(78% vs. 31%), low body mass index, child-Pugh C grade(62% vs. 26%), long term of using anti-hepatitis virus drugs(70% vs. 55%), appetite tobacco and alcohol(82% vs. 57%), history of chronic hepatitis B(80% vs. 30%) in the research group were higher than those in the control group. The differences were statistically significant(all P<0.05). The above factors were positively correlated with the incidence of osteoporosis, which were risk factors. Regular using calcium tablets, activity were negatively correlated with the incidence of osteoporosis, which were protective factors. Conclusion The risk factors of chronic hepatitis B with osteoporosis are female, older age, lower BMI, child-Pugh C grade, long term of using anti-hepatitis drugs and corticosteroids and unhealthy life style. Avoiding these risk factors can reduce the incidence rate.