Do Osteogenesis Imperfecta Fractures Decrease in Adulthood?

Many people with osteogenesis imperfecta (OI) wonder if their bones will become less prone to breaking as they grow up. For most individuals, the answer is yes—fractures tend to decrease significantly during early and middle adulthood ^[1]. However, fracture risk does not stay low forever, and it is important to understand how your bones will change across different stages of life.

The lifetime pattern of fracture risk in OI is often described as “U-shaped.” This means that fractures are most common in early life, drop down during early adulthood, and then slowly rise again later in life ^[1].

Childhood and Adolescence: The Peak Years

During childhood and adolescence, your bones are actively growing and changing ^[1]. Because of this rapid growth, fractures are generally at their highest frequency during these years ^[1]. Limb fractures are particularly common during this active stage ^[1].

Early and Middle Adulthood: The “Honeymoon Period”

When you finish puberty, your growth plates (areas of developing cartilage tissue near the ends of long bones) close, and your body stops growing taller. At this point, many people with OI enter what doctors sometimes call a “honeymoon period.” During early and middle adulthood, bone stability generally improves, and fracture rates drop significantly ^[1]. While fractures can still happen, they are usually much less frequent than they were during childhood ^[1].

• Pregnancy: While fracture risk is generally lower during these years, the physical and hormonal demands of pregnancy can temporarily impact bone health and increase the risk of fractures for some individuals ^[1].

Later Adulthood: New Changes and Risks

As you age—typically starting in your 50s or around the onset of menopause—natural biological changes begin to affect your bone strength again. For people with OI, this means fracture risk can start to climb back up ^[1].

Factors contributing to this secondary increase in fracture risk include:

• Natural aging: As everyone ages, they naturally lose bone density. For both men and women with OI, this age-related bone loss adds to the existing genetic fragility of their bones ^[1].
• Menopause: For women, the drop in estrogen during and after menopause causes a more rapid decrease in bone density, noticeably raising the risk of fractures ^[1].

During these later stages of life, the types of fractures that occur may also change. While limb fractures remain common, the risk for fractures in the axial skeleton—specifically the spine, hip, and femur (thigh bone)—increases as you get older ^[1][1].

Protecting Your Bones Over Time

Because fracture risk can increase again later in life, proactive bone care is essential. Work with your healthcare team—which may include specialists like endocrinologists, orthopedic doctors, and physical therapists—to monitor your bone density. You can discuss when bone-strengthening medications might be appropriate and explore safe, low-impact exercises (like swimming or water aerobics) to support your overall strength and mobility.