Has improved owing to the availability of many drugs that prevent fractures

Osteoporosis is characterised by bone fragility due to low bone mass and modifications of the internal bone structure, with alterations of its microarchitecture. Of various fragility fractures that represent the major complication of the disease, vertebral and hip fractures are associated with pronounced morbidity and increased mortality.1 Several agents have been used for many years to prevent or treat osteoporosis. However, methodologically sound randomised controlled trials assessing their efficacy against fractures at the axial (vertebral) and appendicular (non-vertebral) sites have become available only in the last 15 years. Most of these trials were recently summarised in systematic reviews.1-3

Bisphosphonates are potent inhibitors of resorption and represent 70% of the worldwide market for drugs used to treat osteoporosis. Alendronate and risedronate were both investigated in well designed, randomised controlled trials, where their ability to reduce vertebral, non-vertebral, and hip fractures was shown—the latter mainly in women with …