When a player reaches 0 Hits, he or she dies. Upon death the player respawns in Lumbridge with a message saying "Oh dear, you are dead". You keep your 3 most valuable items when you die (however you don't keep stackable items such as coins or runes), unless you are "skulled" (you have a skull over your head) which is from attacking another playing in the Wilderness. If you die while being skulled, you lose all of your items. The skull lasts for 20 minutes. However, if you die in a duel, you will keep all of your items except staked ones. Any items that are lost can be picked up again so long as another player does not pick them up, or if they disappear after two minutes.
Having the Protect Items prayer active increases the amount of items retained on death to 4, while it increases those of skulled players to 1.