Osseous complications are an important cause of long-term morbidity in renal transplant recipients. The etiology of these complications is multifactorial and relates to abnormalities of calcium homeostasis that persist after engraftment along with toxic effects of immunosuppression. Though we do not yet have a proven strategy to prevent or treat these osseous disorders, effective control of secondary hyperparathyroidism as well as strategies to limit bone loss may prove beneficial, particularly with regard to avoiding the rapid initial bone loss after transplantation. In addition to steroid sparing strategies, potential treatments that include antiresorptive agents (such as calcitonin or bisphosphonates) or anabolic agents which antagonize the effects of corticosteroid (such as rhGH) may be useful. Clinical trials are needed to examine the potential benefit of anti-resorptive and osteoinductive agents in allograft recipients. Although the overall incidence of osseous complications may be decreasing, improved graft survival rates will ensure that skeletal complications remain a significant clinical problem.