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Anti-osteoporotic drug (AOD) trials have variabilities in duration and fracture risks. This study evaluated AOD's versus controls regarding reduction in relative rates (rr) and rate differences (rd) of vertebral and hip fractures and comparative costs. Primary randomized-controlled trials (RCT's) of AOD's in post-menopausal women with documentation of vertebral fracture rates (VFR) or hip fracture rates (HFR) were extracted from meta-analyses and PubMed through February 2021. Direct and indirect meta-analysis and meta-regression analyzed