Forty-eight infants of birthweight less than 1000 g who survived for more than 28 days, had wrist X-rays to prospectively determine the incidence of radiological rickets. Twelve infants (25%) had normal X-rays throughout, 10 infants (21%) showed osteopenia and 26 infants (54%) had classical changes of rickets of which 8 (17% of the total) had spontaneous fractures. There was poor correlation between peak values of serum alkaline phosphatase and the radiological changes.