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Summary Objective We recently reported that children with idiopathic short stature (ISS) have decreased lumbar spine bone mineral density (BMD) that increases after 1 year of GH therapy. The aim of this study was to confirm these short-term results and to evaluate the effect of long-term GH therapy on the BMD of children with ISS. Patients and Design We treated a group of 16 short, slow-growing but otherwise healthy non-GH-deficient prepubertal children (8 girls and 8 boys) with a chronological age of 9·5 ± 0·9 years, a bone age of 8·1 ± 1·2 years and a height of 124·3 ± 6·3 cm (height-SDS of −2·1 ± 0·6) with GH at a dose of 0·1 IU/kg/day for 3 consecutive years. Measurements Height was determined at 3-month intervals and annual growth velocities were calculated. Bone ages and BMD were measured every 12 months by dual-energy X-ray absorptiometry, as were serum concentrations of the carboxy-terminal propeptide of type 1 collagen (PICP) and the carboxy-terminal cross-linked telopeptide of type 1 collagen (ICPT). Results Growth velocity increased from 4·0 ± 0·8 cm/year to 8·7 ± 1·5 and 8·0 ± 1·7 cm/year at 12 and 36 months of GH therapy, respectively, while height-SDS improved from −2·1 ± 0·6 to −1·6 ± 0·4 after 36 months of GH (P