Osteoporosis in children is rare and usually secondary to an underlying disease process whoseÂ diagnosis may be difficult to detect. It can be a manifestation of acute lymphoblastic leukemia (ALL).Â About a-quarters of children with ALL will have signs and symptoms of osteoporosis. We report the caseÂ of a seventh-year-old boy with back pain. His antero-posterior pelvic radiograph showed the osteoporoticÂ bone. The bone age study revealed six-year-old bone. Review of peripheral blood smear showedÂ normochromic anemia with thrombocytopenia. Immunophenotyping of peripheral blood revealed noÂ dominant marker was seen, but the bone marrow aspiration confirms the diagnosis of ALL (L2).