Osteoporosis has became a serious public health problem in the world. Nowadays it has been paid closely attention to the prevention and treatment of osteoporosis and osteoporotic fracture. Alendronate is a common therapy to treat osteoporosis, which has an evident effect on increasing BMD, and reducing osteoporotic vertebral fractures and new fractures. Compared with other antiresorptive agents, alendronate has a stronger effect on increasing BMD. However, there is no strong evidence that alendronate could prevent adjacent vertebral fracture after vertebral augmentation.