The aim of this study was to carry out a comparative analysis of the efficiency of ibandronate monotherapy and combined therapies with ibandronate and alfacalcidol in women with postmenopausal osteoporosis.Materials and Methods: A total of 53 women (mean age 60.7 years) with postmenopausal osteoporosis (PMO) were randomized to monotherapy with ibandronate 150 mg/month (Group Ib) (n=25) and therapy with ibandronate 150 mg/month plus alpha-D 3 (AD3) 1μg (alfacalcidol) daily (Group Ib+AD3) (n=28). All women received calcium and vitamin D 3 supplements. Patients were recruited in one center and were followed up for 6 months on a monthly basis. To assess the efficacy of therapy, BMD was measured at LS (L1-L4) and PF at the beginning and end of therapy by DEXA. Biochemical markers of bone turnover were also assessed.Results: Statistically significant increases in BMD compared with baseline values and the control group were observed in both ibandronate treatment groups. Growth of BMD was significantly higher in Group Ib+AD3 compared to Group Ib. An assessment of CTX dynamics showed a notable decrease in CTX level in patients of both groups compared with levels before treatment. Generally, PTH level decreased insignificantly, but a more pronounced reduction was seen in Group Ib+AD3. TP1NP level significantly increased in Group Ib and was more pronounced in Group Ib+AD3.