Ibandronate: is there an effect on nonvertebral fractures?

Although ibandronate improves suboptimal compliance in patients receiving weekly bisphosphonates, there is a concern about its effect on the reduction of nonvertebral fractures. In the era of evidence-based medicine, randomized clinical trials are considered the highest quality evidence which guide us to the best clinical decision. Nevertheless, if level 1 evidence is not available, as is the case with ibandronate, evidences of lower levels could be used to draw relevant clinical decision. In this article, we discussed data from clinical trials (subgroup analyses of high-risk patients, meta-analysis of clinical trials) which suggested significant effect of ibandronate on the risk reduction of nonvertebral fractures.