Postmenopausal osteoporosis is a major concern to public health. Fractures are 
the major clinical consequence of osteoporosis and are associated with 
substantial morbidity, mortality and health care costs. Bone strength 
determinants such as bone mineral density and bone quality parameters are 
determined by life-long remodeling of skeletal tissue. Receptor activator of 
nuclear factor-kB ligand (RANKL) is a cytokine essential for osteoclast 
differentiation, activation and survival. Denosumab (Prolia®) is a fully human 
monoclonal antibody for RANKL, which selectively inhibits osteoclastogenesis, 
being recently approved for the treatment of postmenopausal osteoporosis in 
women at a high or increased risk of fracture by the FDA in the United States 
and by the European Medicines Agency in Europe since June 2010. FREEDOM, DECIDE 
and STAND are the phase 3 trials comparing denosumab with placebo and 
alendronate in postmenopausal osteoporosis. The authors aim to update denosumab 
role in postmenopausal osteoporosis with a physiopathological review.