There is an increasing appreciation among physicians about the importance of bone health in children as a potential modifiable risk factor for development of osteoporosis later in life. Many unanswered questions about normal pediatric bone health make the treatment and clinical investigation of bone disease in children with chronic rheumatic diseases challenging. Understanding normal bone biology along with the epidemiology and diagnosis of osteoporosis is the key to the understanding of the potential for abnormal bone metabolism in the juvenile rheumatic diseases.