Background: Metabolic bone disease (MBD) of prematurity, also called osteopenia of prematurity is a condition characterized by reduction in bone mineral content (osteopenia), and is caused by several nutritional and biochemical factors. It is a problem facing low birth weight (LBW) infants less than 1500 g. and less than 34 weeks of gestational age due to lack of fetal mineralization during the last trimester. Methods: A prevalence (cross-sectional) study was conducted on 60 newborn infants of both sexes ≤ 34 weeks gestational age and < 1500 g. birth weight for evidence of osteopenia of prematurity by wrist/knee x-ray and to assess serum alkaline phosphatase (ALP) level as an indicator for osteopenia by serial measurements at week 1 and week 2. Results: 8 infants (13.3%) had evidence of osteopenia in X-ray while 52 infants (86.7%) were non-osteopenic and all the osteopenic infants were <1000 g. birth weight. The study also revealed that both birth weight and gestational age were significantly inversely related to both serum alkaline phosphatase (ALP) level and radiologic evidence of osteopenia with no constant value of serum alkaline phosphatase (ALP) related to radiologic evidence of osteopenia but the optimal cut-off point with alkaline phosphatase level 500 IU/L revealed 100% sensitivity and 80.77% specificity. Conclusion: The incidence of MBD of prematurity is steadily decreasing due to improvement in nutritional management. The reliability of alkaline phosphatase levels as the only factor to predict the status of bone mineralization and to perform radiographic evaluation for osteopenia are still conflicting and birth weight <1000 grams or gestational age <32 weeks are more sensitive indicators of osteopenia.