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Low bone density for age is becoming an increasingly recognized problem in the pediatric world. It can be a very tricky condition to properly diagnose and treat. Current treatment guidelines maintain that bisphosphonates are a last resort therapy and are not currently FDA approved for pediatric use. There is data available that supports the use of these agents in children for the treatment of low bone density, as well as secondary benefits, i.e. decreased incidence of insufficiency fractures. However, the majority of the studies includes small population sizes, they are not randomized, or are not compared to a control group. There is clearly a need for further investigation. METHODS: 36 patients from the Carrie Tingley Bone Health Center were included as treatment subjects (received IV and/or PO bisphosphonates) in this retrospective review of pre and posttreatment Dual-Energy X-Ray Absorptiometry (DXA) scans. They were compared to a control group of 30 patients, also with low bone mineral density. Statistical comparison of the differences of bone mineral density, g/cm2, of each region scanned was done with the Mann-Whitney test. RESULTS: A statistically significant improvement over the control group was found in the lumbar region of patients receiving treatment. Mean improvement for the lumbar region of the treatment group was 0.091 g/cm2, compared to 0.032 g/cm2 for the control group; P-value of 0.03. Average treatment length is 14.5 months, (range 0.5 to 53). The treatment group also demonstrated an 88% decrease in the occurrence of fractures, as well as an average 17% improvement in the R1 region of the distal femur. CONCLUSIONS: Bisphosphonate therapy led to a statistically significant improvement in BMD in the lumbar region and potentially decreases the rate of fractures.'