Patient adherence to many osteoporosis treatments, primarily bisphosphonates, is 
generally poor, thus leading to a significant reduction in antifracture 
efficacy. Patient perceptions about the necessity of the prescribed medication 
to treat osteoporosis and the concerns about the potential adverse effects are 
important and potentially modifiable determinants of adherence, in addition to 
other factors, such as difficult dosing regimens and high dosing frequency. 
Denosumab (Dmab) is a fully human monoclonal antibody against the receptor 
activator of nuclear factor-κB ligand (RANKL), which, through the prevention of 
the RANKL/RANK interaction, inhibits osteoclast-mediated bone resorption and 
significantly reduces the risk of vertebral, nonvertebral, and hip fractures. It 
is administered subcutaneously every 6 months for the treatment of 
postmenopausal osteoporosis. Preference and adherence to Dmab treatment were 
assessed in various clinical trials. Although with some limitations, available 
data suggest that Dmab is preferred to bisphosphonates, produces greater 
satisfaction than bisphosphonates, and would be preferentially chosen for 
long-term treatment. Moreover, patient perceptions about the necessity of Dmab 
treatment clearly outweigh the concerns about the injections, and positive 
beliefs about treatment positively influence medication-taking behavior. 
According to these data, Dmab may represent a reasonable alternative to 
bisphosphonates, particularly for osteoporotic women in whom a suboptimal or 
even poor adherence to oral treatments is expected.