BACKGROUNDS: Hormone replacement therapy is effective for improvement of climacteric symptoms, and prevention of postmenopausal osteoporosis but patient compliance is very low. The aim of the study was to assess the comprarative effects on bone mineral density(BMD), lipid, mammographic finding, biochemical bone markers of tibolone and continuous combined hormone replacement therapy in postemeopusal women. METHODS: Body mass index, BMD in the spine and femur neck. lipid, alkaline phosphatase, serum osteocalcin, urine deoxypyridinolone were measured before and after 1 year therapy in 88 postmenopausal subjects. Of these, 54 women received CEE 0.625 mg and MPA 2.5 mg (CEE/MPA) per oral, 34 tibolone alone for 1 year. RESULTS: Body mass index didn't changed in both groups. Significantly increased mammographic density in CEE/MPA groups(p<0.05). Total cholesterol was decreased in both group, but no significant differences between the different treatment groups. Triglyceride decreased in tibolone group and there are significant difference between the two groups(P<0.01). HDL cholesterol increased in CEE/MPA group(p<0.01) but decreased in tibolone group(p<0.01). There are significant difference in HDL cholesterol response between two groups(p<0.01). LDL cholesterol decreased in CEE/MPA group(p<0.01) and significant difference in LDL cholesterol response between two groups(p<0.05). Total alkaline phosphatase(TALP) and serum osteocalcin decreased in both groups(p<0.01) but no differences between two groups. Urine deoxypyridinoline was not decreased in both groups and no differences between two groups. Spine bone mineral density(BMD) increased in both groups(p=0.0001) but no differences in treatment response between two groups. Femur neck BMD didn't not increased in both groups and no differenced of treatment responses between two groups. CONCLUSION: Tibolone was effective on BMD of lumbar spine as much as CEE/MPA and may be safe in terms of mammographic changes in postmenopausal women.