Acute lymphoblastic leukemia (ALL) is the most common childhood malignancy, with a survival rate of 80%. Major complications of leukemia include osteoporosis that requires both a clinically significant fracture history and low bone mineral density (BMD). The present study aims to assess BMD among acute lymphoblastic leukemia patients and survivors using dual-energy x-ray absorptiometry and serum insulin growth factor binding protein 3. The study was approved by the Independent Ethics Committee and the Scientific Council of the Menoufia University, Egypt. Thirty patients with ALL and thirty survivors who were diagnosed with ALL but completely recovered were enrolled in this study. Sex and age matched normal controls while full history was taken. Patients and survivors were examined for anthropometric measurement. Laboratory including serum IGFBP3and dual-energy x-ray absorptiometry was done for all. It has been found out that patients and survivors showed a markedly lower BMD than normal population but no history of fracture was found in survivors. In this study, the prevalence of low BMD is 26/30 (86.6%) patients and 25/30 (83.3%) survivors. Also, there was a statistically significant decrease of DEXA scan measures in patients and survivors groups than the control group with a statistically significant decrease in both BMD and Z- score measures in patients and survivors groups than control group. Patients and long-term survivors of childhood ALL are at risk for morbidity associated with low BMD. They may benefit from interventions to optimize bone health as they age.