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. There is much research 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.