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We have known of the increased risk of prematurely reduced bone mineral density (BMD) in children and young adults with cystic fibrosis since Mischler’s work of 20 years ago1 which documented significant deficiency in 44% of 27 patients. Bone metabolism, however, remained until recently an under-researched area of cystic fibrosis care, perhaps because patients were not expected to live long enough for osteoporosis to become a clinical problem. The average age at death is now over 30 years. Today’s young children with cystic fibrosis are expected to live into middle age. Long term survival after lung transplantation is creating a cohort of patients who enter their new lives with a low bone mineral content which is then subjected to a further damaging assault by immunosuppressive therapy. The threat of osteoporosis with all its attendant complications is a problem for all involved in the care …