An important role for the neuropeptide Y receptor system in the regulation of bone formation was recently revealed with a significant elevation in trabecular bone formation and bone volume following germline or hypothalamus-specific deletion of neuropeptide Y2 receptors in mice. Subsequent studies have now demonstrated that this central pathway is distinct from that of the other centrally regulated bone formation pathway mediated by leptin. This review discusses these recent findings and outlines how these new pathways could translate into potential novel targets for the treatment of bone disease.