Abstract
Four of 11 children with acute lymphoblastic leukemia on long‐term methotrexate therapy developed severe bone pain in their distal extremities. All were in good clinical and hematologic remission. Radiologic examination revealed severe osteoporosis with associated fractures in 5 of these 11 children. A trial of local radiotherapy was attempted in one patient with no response. Methotrexate therapy was stopped in 4 patients with marked improvement in their bone pain and osteoporotic lesions.