Osteoporosis in children is often an undiagnosed condition. Diagnosis is usually made after several fractures occur with minimal trauma or radiographs demonstrate hypodense bones. The relationship of bone mineral density (BMD) to fracture risk in children is controversial. In our study, we were referred 16 patients between the ages of 5 and 15 years who had had two or more fractures without serious trauma. Dual-energy X-ray absorptiometry (DEXA) scans were performed to determine each patient's BMD. The mean bone density of the hip for these 16 patients assessed by z-score was -2.78 +/- 1.4 (SD); the mean BMD of the spine assessed by z-score was -3.08 +/- 1.2 (SD). Fifteen of 16 patients were osteoporotic or osteopenic in either the hip or the spine; 12 patients were osteoporotic in both the hip and the spine; one patient was osteoporotic only in the spine. These data strongly suggest that children with multiple fractures should be screened for osteoporosis.