OBJECTIVE: To investigate the changes of bone mineral density (BMD), biochemical bone markers, and lipid profiles after combination therapy of continuous hormonal replacement therapy (c-HRT) and alendronate in postmenopausal osteoporosis. METHOD: We studied 89 women with postmenopausal osteoporosis (T-score<2.5) who visited at Department of Rehabilitation Medicine, Kosin Medical Center from August 1999 to March 2001. Subjects were divided into two groups; Group I (n=40), treated with estrogen and alendronate (10 mg/day), and Group II (n=49), treated with estrogen alone. BMD at the lumbar spine and femur, osteocalcin, urine deoxypyridinoline and lipid profiles were measured at baseline and 1-year after treatment. RESULTS: 1) BMD at the lumbar spine increased significantlyin two groups, and BMD in Group I increased significantly more than that in Group II. But, change of BMD on femoral neck was not significantly different. 2) Biochemical bone markers (osteocalcin and urine deoxypyridinoline) decreased significantly in two groups. 3) Total cholesterol and LDL cholesterol decreased significantly in two groups, but HDL cholesterol and triglyceride showed no significant change in two groups. There was no significant differences between two groups in lipid profiles. CONCLUSION: We concluded that combination therapy with c- HRT and alendronate in postmenopausal osteoporosis was more effective than c-HRT, which would not influence on positive effect of estrogen for lipid metabolism.