There is a high prevalence of osteopenia and osteoporosis among both adult and pediatric patients with CF and this steadily increases with age. There is also an associated increase in fracture rate and kyphosis in adults. Studies evaluating fracture risk in children with CF have generated mixed results. Henderson et al reported an increased rate of fracture in girls with CF, but not boys, in comparison to healthy controls. A more recent study by Rovner et al showed no increase in fracture risk among children with mild to moderate lung disease. Bisphosphonates have been used to treat osteopenia and osteoporosis in adults with CF and clinical trials have shown that there is an increase in bone mineral density (BMD) with therapy. However, there is no published data demonstrating a reduced fracture rate with bisphosphonate therapy. Furthermore, there is currently no consensus on how to treat osteopenia or osteoporosis in children with CF other than to ensure adequate nutrition and vitamin D levels. Although CF bone disease is considerably more prevalent in the adults than in children, screening for bone disease must be addressed in childhood to maximize peak bone mass and potentially minimize bone related disease in these patients.