Metabolic bone disease is becoming a more recognized disease entity. Endocrine disease often is associated with metabolic bone disease. This article attempts to delineate the current knowledge of osteoporosis and osteomalacia in endocrine diseases. As the population ages, the amount of metabolic bone disease and number of fractures will increase. It is imperative that health care providers screen and treat patients at risk of metabolic bone disease. Much research is ongoing in this field and the number of treatment options will greatly expand. Focusing on ways to maximize the development of the fetal skeleton to improve peak bone mass, such as improving maternal vitamin D levels during pregnancy, may best address the treatment of osteoporosis and osteomalacia for the entire population.