Bone health is an ever important aspect in the care of children and adolescents. In this review article, we will discuss the basic physiology of bone metabolism, including bone formation and remodeling. We will discuss the process of bone mass accretion and the elements that influence the establishment of peak bone mass. We will discuss the various measurement methods for bone density. We will explore risk factors contributing to osteoporosis, such as physical inactivity and calcium and vitamin D deficiencies. Furthermore, we will review bone disorders that are associated with common endocrine conditions, such as hyperthyroidism and Turner syndrome. Lastly, we will discuss the effect of chronic disease on the overall bone health of children and adolescents, including celiac disease, HIV, and systemic lupus erythematosus. In conclusion, achieving and maintaining bone health in children and adolescents are essential for the optimization of growth and development. Early identification and avoidance of risk factors for osteoporosis, as well as adequate treatment of chronic illnesses affecting bone accrual, will allow for the optimization of bone health in children and adolescents.