Osteoporosis is increasing due to the aging of the population. Women with cognitive impairment from childhood are at disproportionally high risk for osteoporosis and fractures. Suggested explanations for this increased risk include high use of anticonvulsant medications, lower peak bone densities, and higher rates of nonambulation. Down syndrome seems to be an independent risk factor for low bone density and fractures, presumably due to lower muscle tone. Here, the limited information available on the epidemiology of osteoporosis in the general population and in women with cognitive disabilities is briefly reviewed. Health care professionals should consider women with cognitive disabilities at high risk for osteoporosis and fractures. Studies are needed to determine screening regimens and prevention strategies appropriate for women in this population.