Are we treating women with postmenopausal osteoporosis for their low BMD or high fracture risk?

In the field of postmenopausal osteoporosis, the quality of bone has gained more attention than the quantity, so the most important part of anti-osteoporotic efficacy of an agent translates its capacity to reduce osteoporotic fractures. Ten years' experience with alendronate has a lot of conflicting data that have to be discussed in detail. Health care professionals in the field of postmenopausal osteoporosis question the antifracture efficacy of a drug more quickly than its favorable effects on BMD. The aim of this paper is to present the complexity of the results in this 10-year trial that has caused difficulty in its interpretation. Ten-year data of alendronate resulted in inconclusive evidence because of the small sample size, high drop-out rate, heterogeneous distribution of subjects in each arm of the trial, and biologically unexplainable results of the fracture rates. The need for further well-designed trials on long-term antifracture efficacy of anti-osteoporotic drugs still remains.