Background: Strontium ranelate, a new oral drug shown to reduce vertebral fracture risk in postmenopausal women with osteoporosis, was studied in the Treatment of Peripheral Osteoporosis (TROPOS) study to assess its efficacy and safety in preventing nonvertebral fractures also.Methods: Strontium ranelate (2 g/d) or placebo were randomly allocated to 5091 postmenopausal women with osteoporosis in a double-blind placebo-controlled 5-yr study with a main statistical analysis over 3 yr of treatment.Findings: In the entire sample, relative risk (RR) was reduced by 16% for all nonvertebral fractures (P ‫؍‬ 0.04), and by 19% for major fragility fractures (hip, wrist, pelvis and sacrum, ribs and sternum, clavicle, humerus) (P ‫؍‬ 0.031) in strontium ranelate-treated patients in comparison with the placebo group. Among women at high risk of hip fracture (age >74 yr and femoral neck bone mineral density T score <؊3, corresponding to ؊2.4 according to NHANES reference) (n ‫؍‬