Lung transplantation (LTx) is a widely recognized therapeutic option for end-stage pulmonary diseases. It has improved not only survival but also quality of life of recipients. Osteoporosis constitutes a medical condition that could affect long-term outcome and eligibility for LTx. Despite this, there is a lack of attention given to this issue by the medical community. There is reported 30% to 50% incidence of osteoporosis among LTx candidates. Risk factors for bone loss in the pre-LTx period are multiple and mainly associated with long-term glucocorticoid therapy. The main cause of bone loss after LTx appears to be immunosuppressive therapy, mostly because of the action of cyclosporine. Similarly, with what has been described for other solid organ transplants, the first 6 to 12 months after surgery is the period with the highest skeletal damage. Prospective studies concerning prevention and treatment of bone loss in this population have yet to be published. On the basis of our observations, we emphasize the need for an early evaluation of bone mass status. Efficient pharmaceutical prevention and treatment of bone loss in all candidates for LTx is required to avoid posttransplant bone quality deterioration. Maintenance of adequate levels of vitamin D and calcium and hormonal replacement when needed are mandatory. Antiresorptive drugs, such as biphosphonates, appear to be the best treatment option. Similarly, in the posttransplant period, it is imperative to continue with the same strategy.