This review is intended to focus attention on the importance of essential metallo-element metabolism, particularly copper metabolism, as an important component of normal bone metabolism in maintenance and repair. Literature published since Rademacher's early (1) astute observation that copper supplementation increases the rate of bone healing documents and explains key roles of copper-dependent processes required for maintenance and repair of this tissue. State of the art approaches to treatment of bone diseases including lengthening of bone and repair of fractures, can be improved by paying closer attention to the roles of copper and other essential metallo-elements required for optimal treatment.