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Abstract Background: Successful kidney transplantation and proper regular hemodialysis correct many of the metabolic abnormalities associated with development of renal osteodystrophy, but despite a well functioning graft , osteopenia and osteoporosis remain prevalent in pediatric kidney recipients , The factors that affect the bone mineral density (BMD) and the long term course of BMD after transplantation in children is still not been adequately studied. Patients & Methodology: We performed a cross sectional study on Post Renal Transplantation Patients in the Nephrology Unit, Cairo University Children{u2018}s Hospital , DEXA scan was done at the start of the study to determine the degree of osteoporosis then the patients were divided into 2 groups ,group } was(13 cases) post renal transplanted children with moderate and severe osteoporosis received Bisphosphonates and active Vitamin D and group S was (18 cases) post renal transplanted children with moderate and mild osteoporosis received Vitamin D only , (6 cases) received inactive vitamin D, (12 cases) received active vitamin D, then DEXA scan was done again after 6 months of treatment , Laboratory investigations done was serum Calcium, Phosphorus , Alkaline phosphatase , PTH and 25 (OH) vitamin D level. Results: There is a significant improvement in osteoporosis after treatment with Bisphosphonates, p value 0.022. In our study, there is no significant improvement after vitamin D therapy (active and inactive ) in treatment of osteoporosis |