Bone damage in the spectrum of chronic kidney disease - mineral and bone disorders (CKD-MBD) represents a daily challenge for pediatric nephrologists. A real measurement of bone mineral density (BMD) by Dual X-ray absorptiometry (DXA) is currently performed to evaluate bone mass in children. However this technique has some limitations. In 2000, the National Institute of Health (NIH) has defined new "quality" criteria for the diagnosis of osteoporosis in addition to a decreased bone mass. Bone strength actually integrates 2 issues: bone density and bone quality (i.e., micro architectural organization, bone turnover, mineralization and micro fractures). These "quality" criteria cannot be evaluated by DXA. Histomorphometry remains the gold standard to evaluate bone but it is rarely performed in clinical practice. New bone imaging techniques have thus been developed, leading to an improvement in bone assessment. They are particularly challenging in children, whose bones continually grow in size, shape and mass.