Osteoporosis is being increasingly recognised in paediatric practice as a consequence of several factors. In addition, the improved medical and nursing care provided to children with chronic illness has led to many of them living long enough to develop osteoporosis. The availability of methods to assess bone density in children as a surrogate marker of bone strength and the possibility of medical treatment to increase bone density have also resulted in an increased awareness of groups of children who may be at risk of osteoporosis. Osteoporosis in children may be primary due to an intrinsic bone abnormality (usually genetic in origin) or secondary due to an underlying medical condition and/or its treatment. The effects of this disease can best be managed with early diagnosis and treatment. In secondary osteoporosis, treatment may include treating the underlying cause of the disease.