Introduction. Osteoporosis is a frequently ignored disease, that has the potential to develop an adverse outcome, leading to complications that lower patients' quality of life. Postmenopausal osteoporosis is a well-studied subject, being a disease with an increasing prevalence. However, there is a large number of drugs to choose from for the treatment of postmenopausal osteoporosis. Bisphosphonates are the most used therapeutic choice but, with an almost 10-year clinical experience, RANKL inhibitor Denosumab is becoming more frequently used in practice, with great results. The main purpose of this review is to evaluate the efficacy of bisphosphonates compared with that of Denosumab by analyzing different parameters. Matherials and methods. We included randomized studies that directly compared bisphosphonates to Denosumab after 1 year of treatment, which included data regarding the bone mineral density (BMD) and bone turnover markers (BTM) measured at baseline and after 12 months. Results. Seven randomized studies were included in this review, combining a total of 4535 patients. In all 7 studies the changes in lumbar spine bone mineral density were statistically significant in favor of Denosumab. Denosumab also produced a decrease in bone turnover markers as early as 1 month from the beginning of the treatment. After 12 months of treatment the reduction percentage of BTM were similar between the two groups. The rate of adverse effects' occurrence is similar between the two groups. Conclusion. Denosumab treated patients present an increase in bone mineral density after 12 months of treatment when compared to bisphosphonates. Both therapies have a similar reduction of bone turnover markers. The rate of adverse effects' occurrence during the 12 months of monitoring were also similar between the two drugs.