Growth Hormone (GH) and Insulin-Like Growth Factors (IGFs) are crucial regulators of bone homeostasis, playing significant roles in both longitudinal bone growth and maintenance of bone mass. GH acts directly on skeletal cells, while most of its effects are mediated through IGF-I, which is present in the systemic circulation and synthesized by peripheral tissues. IGF-I enhances osteoblast function and bone formation, and its availability is regulated by IGF binding proteins (IGFBPs). Adult GH deficiency leads to low bone turnover osteoporosis, with a high risk of vertebral and nonvertebral fractures, which can be partially reversed by GH replacement. Acromegaly, characterized by high bone turnover, can lead to bone loss and vertebral fractures, particularly in patients with coexisting hypogonadism. The decline in GH and IGF-I secretion with aging contributes to the development of osteoporosis, and abnormalities in the GH/IGF-I axis play a role in the pathogenesis of osteoporosis associated with anorexia nervosa and glucocorticoid exposure. The review highlights the mechanisms of GH and IGF-I action in bone, the skeletal manifestations of GH deficiency and excess, and the role of these hormones in selected forms of osteoporosis.Growth Hormone (GH) and Insulin-Like Growth Factors (IGFs) are crucial regulators of bone homeostasis, playing significant roles in both longitudinal bone growth and maintenance of bone mass. GH acts directly on skeletal cells, while most of its effects are mediated through IGF-I, which is present in the systemic circulation and synthesized by peripheral tissues. IGF-I enhances osteoblast function and bone formation, and its availability is regulated by IGF binding proteins (IGFBPs). Adult GH deficiency leads to low bone turnover osteoporosis, with a high risk of vertebral and nonvertebral fractures, which can be partially reversed by GH replacement. Acromegaly, characterized by high bone turnover, can lead to bone loss and vertebral fractures, particularly in patients with coexisting hypogonadism. The decline in GH and IGF-I secretion with aging contributes to the development of osteoporosis, and abnormalities in the GH/IGF-I axis play a role in the pathogenesis of osteoporosis associated with anorexia nervosa and glucocorticoid exposure. The review highlights the mechanisms of GH and IGF-I action in bone, the skeletal manifestations of GH deficiency and excess, and the role of these hormones in selected forms of osteoporosis.