Metabolic diseases may cause alterations in mass, mineralization, turnover, and growth of bone. They may be caused by genetic, endocrine, nutritional, or biochemical disorders. The bone is affected as a tissue, but radiological features may not be always evident, or evident in every bone. A basic knowledge of the pathophysiology of metabolic bone diseases is essential to the understanding of the effects that metabolic bone disorders have on the skeleton, to help interpret the abnormal features which they cause on imaging of the wrist and hand. Osteoporosis is the most common metabolic disease, characterized by low bone mass and microarchitecture degeneration with impaired bone quality, resulting in increased skeletal frailty and thus increased risk of fractures, which are particularly common around the wrist. Other metabolic conditions affect bone around the wrist and hand in diverse ways, and have distinctive features, in some cases, virtually diagnostic. In this chapter we will review the manifestations of metabolic bone disease around the wrist and hand, reviewing the essentials for diagnosis. We will also focus on the possibilities the wrist and hand offer to the quantitative diagnosis of metabolic bone disease, through established and advanced techniques.