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Seasonal and interindividual differences in food availability and illnesses cause variations in growth, including bone growth, in children in developing countries. We investigated seasonal differences in biochemical (serum) markers of bone metabolism and relationships between these markers (procollagen type I N propeptide [P1NP], serum C-terminal telopeptide of type 1 collagen [S-CTX]) and serum markers of inflammation (alpha(1)- antichymotrypsin [ACT], C-reactive protein [CRP], sialic acid) in prepubertal Gambian boys. Three seasonal time points were chosen: August, mid-rainy season; October, late rainy season (both are associated with decreased food supply, increased prevalence of infection, reduced weight gain, and stunting); and April, late dry season, when environmental conditions are better and rates of weight gain are higher. The prevalence of raised inflammatory markers was high: 29% of ACT values >0.40 g/L in August, 42% >0.40 g/L in October, and 18% >0.40 g/L in April. Of CRP values, 92-96% were >0.47 mg/L and 30%, 46%, and 18% were >3.95 mg/L in August, October, and April, respectively. Also, 42-52% of sialic acid values were >648 mg/L. Of the bone markers, S-CTX exhibited the highest values in August; P1NP did not vary with season. Inverse relationships between each bone marker and the acute phase markers occurred, with the strongest relationships between P1NP and ACT or sialic acid. We conclude that bone collagen synthesis and turnover are reduced during inflammation in rural Gambian boys. Biochemical indices can provide powerful, single-time point evidence of infection and growth-faltering episodes.