A double-blind controlled study was performed in 60 patients with symptomatic osteoporosis with at least one vertebral crush fracture, comparing the effect of nandrolone decanoate, 1 alpha-hydroxyvitamin D3 and intermittent calcium infusions. Thirty-four out of 60 patients completed the 2 year observation period. Nandrolone decanoate statistically significantly increased the bone mineral content at the radius, reduced the endosteal bone loss at the metacarpals and statistically significantly reduced urinary calcium and hydroxyproline excretion. Calcium infusions and 1 alpha-hydroxyvitamin D3 inhibited further loss of bone mineral content, but endosteal bone loss continued. In the second year fracture rate was reduced in the nandrolone decanoate groups compared to the two other groups. We conclude that nandrolone decanoate is an active drug for increasing bone mineral content and reducing endosteal bone loss, while 1 alpha-hydroxyvitamin D3 and calcium infusions only stop further bone mineral loss at the radius but do not inhibit endosteal bone loss as measured at the metacarpals and that single photon absorptiometry and radiography are complementary in interpreting cortical bone mineral changes.