Ding LL, Wen F, Wang H, et al. - Since no studies have correlated various osteoporosis drugs in postmenopausal women (PMW) either with or without prevalent vertebral fracture (PVF). Researchers sought to compare them in the two different subgroups. The Bayesian random-effects network meta-analysis was performed to synthesize hazard ratio (HR) and 95% confidence interval (CI) for clinical fracture stratified by PVF and to synthesize risk ratio (RR) for tolerability and vertebral fracture. In this study, 33 trials were selected including 79,144 postmenopausal women. In both of the two populations, different effective drugs should be applied to prevent fragility fractures according to PMW with or without PVF, and romosozumab is the only one that can decrease clinical and vertebral fractures. PTH and abaloparatide were found to be less tolerable than placebo whereas the eight other drugs evaluated in the study have the same tolerability as placebo.