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-effects. 25 Numerous advancements in osteoporosis pharmacotherapy have occurred in the last decade, including the introduction of the monoclonal antibody denosumab. Acting as an inhibitor of the receptor activator of nuclear factor kappa-Β (RANK) ligand (RANKL), denosumab selectively inhibits osteoclast activity via the RANKL-Osteoprotegerin (OPG) axis without impeding osteoblast activity to maintain bone density. 1 Unlike other antiresorptive therapies, it is available in a convenient 60-mg subcutaneous injection delivered every 6 mo. 1 , 27