Despite a statistically proven efficacy of aminobisphosphonates (risedronate and alendronate) in preventing fractures of the proximal femur, their effect only applies to elderly osteoporotic patients who already suffered a fracture. In women under to who already suffered an osteoporotic fracture, all available antiresorptive drugs (raloxifene, calcitonin, risedronate and alendronate) are capable of decreasing the risk of vertebral fracture. The magnitude of this effect after 4-5 years therapy using all the above-mentioned drugs is similar, even though different mechanisms are exerted. Raloxifene, risedronate and alendronate all demonstrably decrease the vertebral fracture risk associated with postmenopausal osteoporosis in women without any previous fracture. Only raloxifene demonstrably decreases fracture risk in women with osteopenia of the proximal femur. The above-mentioned antiresorptive drugsmeet the requirements for successful long-term osteoporosis treatment to a varyiing degree. They differ in efficacy (fracture risk reduction), degree of bone quality improvement, beneficial effects on tissues other than bone and acceptable risk of long-term side effects. All of these criteria are prerequisite for long-term compliance and adherence to treatment. They should applied prior to treatment initiation in patients with postmenopausal osteoporosis considering their age, individual fracture risk within the next 5-10 years and other health conditions.

        Key words: osteoporosis - bisphosphonates - raloxifene - teriparatide - fracture.