Recent non-placebo-controlled studies of the bisphosphonate pamidronate have shown it to be effective in reducing fractures and improving bone density in infants and children with osteogenesis imperfecta (OI). To evaluate the effects of bisphosphonate treatment in a controlled study, the oim/oim mouse model of OI was studied. Nursing infant mouse pups (~2 wk old) with moderate to severe OI (oim/oim mouse) and age-and background-matched control mice (ϩ/ϩ) were treated either with the third-generation bisphosphonate alendronate (ALN), or with saline. Fracture risk, bone quality, and growth were evaluated over a 12-wk treatment period. ALN at a dose of 0.03 mg/kg/d or saline was administered via s.c. injection to infant oim/oim and wild-type (ϩ/ϩ) mice from 2 to 14 wk of age (n ϭ 20 per subgroup). The average number of fractures sustained by the ALN-treated oim/oim mice was reduced significantly compared with the untreated oim/oim mice (0.7 Ϯ 0.7 fractures/mouse versus 2.0 Ϯ 0.2 fractures/mouse). Bone density increased significantly in the femur and the spine with treatment (2.0 Ϯ 0.5 versus 1.2 Ϯ 0.5 in femur and 2.1 Ϯ 0.5 versus1.6 Ϯ 0.5 in spine). Histologic evaluation revealed the percentage of metaphyseal tibial bone increased significantly with treatment in both ϩ/ϩ and oim/oim mice. Mechanical testing revealed an increase in structural stiffness for both treated ϩ/ϩ and oim/oim mice compared with untreated animals. None of the material properties examined were significantly altered with treatment, nor was spinal curvature affected. Weight gain and long bone growth were comparable in the treated and untreated oim/oim mice. In wild-type mice, femur lengths were significantly shorter in the treated mice compared with untreated counterparts. This animal study demonstrates that treatment of OI in mice as early as 2 wk of age with ALN appears to be effective in reducing fractures and increasing bone properties. Based on the data from this study, ALN therapy in infants with OI should prove to be effective. Abbreviations OI, osteogenesis imperfecta oim/oim, mice homozygous for spontaneous mutation causing the skeletal defects of OI ؉/؉, wild-type mice AP, anteroposterior ML, mediolateral BMD, bone mineral density ALN, alendronate OI, also known as "brittle bone disease," occurs in about 1 in 20,000 births (1). The real incidence is probably higher because a significant number of children are not diagnosed at birth due to mild expression of the disease (2). OI is predominately a collagen defect, caused by heterogeneous genetic mutations that result in an array of clinical manifestations, ranging from blue sclerae and dentinogenesis imperfecta to extremely short stature and progressive limb/spine deformities secondary to multiple fractures. Surgical treatment of the extremities and spine are often indicated to stabilize the long bones and optimize functional ability and walking capacity. According to the Sillence classification (3) there are four forms of OI, although recent data has added additional variants (4). Typ...