Two thousand twenty-six postmenopausal women with osteoporosis at highest fracture risk were randomized to receive either abaloparatide (n=664), teriparatide (n=685), or placebo (n=677) for 18 months. The primary outcome was incidence of new vertebral fractures. Secondary outcomes included incidence of nonvertebral, clinical, major osteoporotic, and wrist fractures, as well as change in bone mineral density (BMD) at the lumbar spine, total hip, and femoral neck. Outcomes were assessed over 19 months (including 1 month post-treatment). Overall, the results of the study revealed significantly lower vertebral fracture rates in the abaloparatide and teriparatide groups compared to placebo, with significant gains in BMD across all measured sites. These findings suggest that abaloparatide is effective in reducing fracture incidence and improving BMD in high-risk postmenopausal women.