To the Editor We read with great interest the article by Köhler-Forsberg et al,1 which found that lithium was associated with a dose-dependent decrease in risk of osteoporosis in patients with bipolar disorder. Fractures are a major concern of patients and are associated with nearly all psychotropic medications2 as well as bipolar affective disorder itself.3 Lithium is an efficacious treatment of bipolar affective disorder and is already underused, according to many experts.4 This study provides a signal for another unique benefit with lithium relative to other mood stabilizers (and even other classes of psychotropic medications like benzodiazepines).