The US Food and Drug Administration has approved a diverse group of effective osteoporosis therapies. However, these therapies obviously only work when patients with osteoporosis take them. Data from retrospective observational databases have shown poor compliance and persistence with all osteoporosis drugs, particularly oral bisphosphonate therapy. Patients on weekly therapies are more compliant and persistent than those on daily dosing. Data have also shown decreased fracture risk, decreased health care utilization, and lower costs in compliant and persistent patients.