Children whose bone biopsy results indicate an adynamic form of osteoporosis and who have low bone turnover markers make up a significant number of the children with symptomatic osteoporosis. Many of these patients have in addition growth failure (due to prolonged glucocorticoid usage and chronic illness) and some may have low growth hormone secretion. In this circumstance, the agent of choice would be an anabolic agent known to increase osteoblast activity, normalize histomorphometric parameters and improve bone quality. Unfortunately, one of the most promising of these agents, recombinant PTH (Teripeptide) is precluded from use in pediatric patients because of concerns regarding induction of osteosarcoma. It is unclear to what extent antiresorptive therapy might achieve these goals, although it has become the therapy of choice by default.