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The rigorously investigated drugs reported to reduce vertebral fractures are alendronate, risedronate, raloxifena and PTH HRT is no longer first choice for fracture prevention given the risk for adverse events, even though these risks are small. Evidence supporting the use of calcitonin, fluoride, anabolic steroids, active vitamin D metabolites is inadequate. The rigorously investigated drugs reported to reduce non-vertebral fractures are the two bisphosphonates and PTH. Evidence for anti-hip fracture efficacy is confined to the two bisphosphonates. Calcium and vitamin D and hip protectors have been reported to reduce hip fractures in institutionalized elderly. Women and men with fragility fractures should be treated with agents that have been thoroughly investigated.
