The purpose of this paper is to discuss the effects of antifracture drugs on postmenopausal, male and
glucocorticoid-induced
osteoporosis, focussing on the efficacy and safety of
alendronate and
risedronate. A search of the literature was conducted using PubMed for strictly conducted systematic reviews published from 1995 to present with homogeneity, meta-analyses with homogeneity, and randomized controlled trials (RCTs) with a narrow confidence interval. According to the results of the systematic reviews and meta-analyses,
alendronate and
risedronate are useful for the prevention of vertebral and non-vertebral fractures in postmenopausal women with
osteoporosis. The results of RCTs have shown the antifracture efficacy of
raloxifene and
ibandronate against vertebral fractures and that of
strontium and
parathyroid hormone against vertebral and non-vertebral fractures in postmenopausal women with
osteoporosis. In addition, the long-term safety of
alendronate,
risedronate and
raloxifene has been established. On the other hand, RCTs have shown that, only
alendronate prevents vertebral fractures in men with
osteoporosis, and that
alendronate and
risedronate can prevent vertebral fractures in patients receiving
glucocorticoid treatment. There seems to be less evidence of the antifracture efficacy of the drugs in male and
glucocorticoid-induced
osteoporosis. They have limitations related to long-term compliance, gastrointestinal intolerance and poor and variable absorption form gastrointestinal tract. Thus, intermittent
intravenous administration of
bisphosphonates such as
ibandronate and
zoledronate or subcutaneous administration of
denosumab might address some of these problems, although the antifracture efficacy of these drugs needs be established. However, antifracture efficacy and long-term safety are important points in the choice of drugs for the treatment of
osteoporosis. Thus, the evidence derived from the literature, based on strict evidence-based medicine guidelines, suggests the antifracture efficacy and safety of
alendronate in postmenopausal, male and
glucocorticoid-induced
osteoporosis, and those of
risedronate in postmenopausal and
glucocorticoid-induced
osteoporosis.