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ABSTRACT: The primary goal of treatment for postmenopausal osteoporosis is the reduction in fracture risk. Bisphosphonates have long been established as first-line therapy for osteoporosis and several of these drugs significantly reduce osteoporotic fracture risk. Alendronate, risedronate, ibandronate and zoledronic acid all provide fracture protection for patients with postmenopausal osteoporosis. All four agents have demonstrated efficacy in preventing vertebral fractures, but only zoledronic acid and risedronate significantly reduce non-vertebral fracture risk in pivotal trials. Moreover, reduction in hip fracture risk has been established for alendronate, risedronate and zoledronic acid. Ibandronate and zoledronic acid have the most persistent antifracture effect. Bisphosphonates have been associated with a number of side effects, with a well-documented association between gastrointestinal adverse events and oral administration, and between acute phase reactions and intravenous administration.Therapeutische Umschau 03/2012; 69(3):173-81.