Calcium, strontium, barium, and radium are alkaline‐earth metals of which calcium is an essential element. The adverse effects associated with excessive calcium intake are kidney stone formation, hypercalcemia, and renal insufficiency. The toxicological effects of calcium are generally associated with sustained increases in its intracellular concentration. Strontium, widely found in association with calcium, causes skeletal toxicity by competing with calcium for binding to form hydroxyapatite crystals. Barium, the heaviest of the stable alkaline earth metals of Group IIA of the periodic table, is a chemical antagonist to potassium. Barium toxicity is mediated by through substitution for calcium, in addition to being a physiological antagonist to potassium ions. Kidney is the primary target organ for barium toxicity in rodents, while cardiovascular effects such as hypertension are the primary effect in humans. Finally, radium, a radioactive element, is an analogue of barium and calcium. Sarcomas of the bone and carcinomas of the paranasal sinuses and mastoid air cells have been associated with radium exposure. This chapter also summarizes the available environmental and workplace guideline values for these alkaline earth metals.