<p>Severe malnutrition in the presence of child maltreatment and other specified feeding or eating disorder (OSFED) can lead to significant effects on bones. We present a case of severe malnutrition from child maltreatment that developed into osteoporosis and persistent electrolyte abnormalities due to hungry bone syndrome (HBS). We describe a 15-year-old female with a history of medical neglect and severe malnutrition presenting to the hospital after removal from mother’s home. The patient was admitted, refed, and monitored for refeeding syndrome. She had an elevated parathyroid hormone (PTH) level, vitamin D deficiency, and electrolyte derangements requiring daily management for weeks. Once obtained, a dual-energy X-ray absorptiometry (DXA) scan demonstrated a total-body-less-head (TBLH) Z score of -5.9. The learning goals of this case are for the readers to: </p><p>● Understand the pathophysiology and typical presentation of HBS. </p><p>● Understand the unique presentation of HBS in the context of malnutrition. </p><p>● Distinguish HBS from refeeding syndrome.</p>