Osteoporotic fractures in older women constitute a major cause of disability, mortality, and economic burden.1 The incidence of fractures related to osteoporosis will increase worldwide over the next three decades as the proportion of women over the age of 65 increases.2 It is therefore important that we identify efficacious treatments that will reduce the incidence of osteoporotic fractures. In the past, randomised controlled trials have focused on the surrogate outcome of bone mineral density. The limitation of relying on a surrogate outcome was highlighted by the results of earlier trials, in which increases in bone density did not translate into decreased risk of fracture.3 As a result of stricter standards that required evidence of efficacy against fractures for drug approval, we now have large randomised trials with prevention of fractures as an outcome. Data from these trials provide information on the strength of the evidence for efficacy of the different treatments.

Evidence based reviews of treatments for postmenopausal osteoporosis have confirmed which treatments reduce the risk of fractures in women with osteoporosis.4^–6 Most currently used drugs are antiresorptive agents that reduce osteoclast …