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Multiple factors impair this process in children undergoing solid organ transplantation, including chronic illness, pretransplant osteodystrophy, use of medications with negative impact on bone, and post\u2010transplant renal dysfunction. While growth delay and short stature remain common, the most severe forms of transplant\u2010related bone disease, fracture and avascular necrosis, appear to have become less common in the pediatric age group. Osteopenia is very prevalent in adult transplant recipients and probably also in pediatrics, but its occurrence and sequelae are difficult to study in these groups due to methodological shortfalls of planar densitometry related to short stature and altered patterns of growth and development. Although the effect on lifetime peak bone mass is not clear, data from adult populations suggest an elevated long\u2010term risk of bone disease in children receiving transplants. Optimal management of pretransplantation osteodystrophy, attention to post\u2010transplant renal insufficiency among both renal and non\u2010renal transplant patients, reduction of steroid dose in select patients, and supplementation with calcium plus vitamin D during expected periods of maximal bone loss may improve bone health. 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