In the field of postmenopausal osteoporosis, the quality of bone has gained more attention than the quantity, so the most important part of anti-osteoporotic efficacy of an agent translates its capacity to reduce osteoporotic fractures. Ten years' experience with alendronate has a lot of conflicting data that have to be discussed in detail. Health care professionals in the field of postmenopausal osteoporosis question the antifracture efficacy of a drug more quickly than its favorable effects on BMD. The aim of this paper is to present the complexity of the results in this 10-year trial that has caused difficulty in its interpretation. Ten-year data of alendronate resulted in inconclusive evidence because of the small sample size, high drop-out rate, heterogeneous distribution of subjects in each arm of the trial, and biologically unexplainable results of the fracture rates. The need for further well-designed trials on long-term antifracture efficacy of antiosteoporotic drugs still remains.