BACKGROUND: Although fluoride has an ability to increase BMD at lumbar spine, it does not result in a reduction in vertebral fractures. After the introduction of monofluorophosphate instead of NaF, there is a revival of the use of fluoride in the treatment of osteoporosis. METHODS: We evaluated 39 subjects out of the 50 who finished a 1-year treatment. Fifty postmenopausal Korean women with decreased bone density were enrolled from Oct. 2000 to Mar. 2001 and stratified 2-groups by treatment regimen. One group was treated with Fluocalcic (Disodium monofluorophosphate; 100 mg and calcium carbonate; 1,250 mg) and HRT, the other group with HRT only at climacteric clinic in Samsung Cheil Hospital & Women's Healthcare Center. Markers of bone turnover, changes of BMD and demographic data were obtained and compared in both groups. RESULTS: Compared with the baseline value, osteocalcin and total alkaline phosphatase, the formation markers of bone turnover were not decreased significantly after 3-month treatment in HRT and fluoride treated group. But, DPYD, the resorption marker, was decreased slightly after the 3-months treatment. Changes of both resorption and formation markers of bone turnover in HRT only treated group were significantly decreased after the treatment. The spinal BMD increased significantly compared to the baseline value in both groups. Changes of spinal BMD after 1-year treatment in HRT and fluoride treated group was increased significantly than HRT only group (15.1 12.6% vs 4.2 3.4%). CONCLUSION: This study shows that changes of spinal BMD after combined treatment with HRT and fluoride were increased significantly than HRT only treatment. Therefore, combined use of Fluoride and HRT was effective to increase spinal BMD in postmenopausal women with decreased spinal BMD.