The available data indicate that HIV-infected children and adolescents have reduced bone mass compared to healthy peers. The increased survival due to the control of HIV infection by potent antiretroviral treatment, exposes patients to the achievement of a reduced peak bone mass and to an increased fracture risk during adult life. Reduced bone mass in HIV-infected children is the result of altered bone metabolism, showing significantly increased bone resorption rate. Both infection per se and the use of certain antiretroviral compounds seem to contribute to the altered metabolism. Preventative measures to improve bone health are thus necessary in all young patients that exhibit low bone mass measurements and altered bone metabolism.