Most treatments showing efficacy in fracture reduction in older people have been over three years. However, strontium ranelate was beneficial in the reduction of all major fractures (including hip and nonvertebral) for up to five years in old, frail and osteoporotic women. Based on the available evidence in this older age group, strontium ranelate would be a suitable firstline option if reduction in vertebral, non-vertebral andhip fractures is the goal. This is notwithstanding other considerations such as dosing, frequency, adherence,tolerability, and patient and clinician preferences.