BACKGROUND: Compliance to therapy is a widespread public health concern especially for chronic diseases, such as osteoporosis, as it is associated with increased morbidity and mortality due to fragility fractures.  OBJECTIVES: To conduct the systematic review of clinical trials evaluating adherence to oral and parenteral bisphosphonates in patients with postmenopausal and senile osteoporosis. METHODS: We searched publications in PubMed and the Cochrane Library in November 2014. Studies of any design published in English were considered. The following criteria of medication adherence were taken into account: persistence rate (percentage of patients remaining on therapy at a given time). compliance rate (percentage of patients act in accordance with the prescribed interval and dose of a dosing regimen), medication possession ratio (proportion of doses dispensed in relation to doses prescribed), persistence (number of days from initiation to discontinuation of therapy). RESULTS: Thirty one publications were included (1 meta-analysis, 5 systematic reviews, 14 RCT, 7 prospective cohort studies, and 4 retrospective cohort studies). Original studies were heterogeneous in terms of drugs, treatment regimes, follow up periods, and measurements of adherence, so quantitative meta-analysis was not possible. The 12 months persistence rate for patients receiving oral bisphosphonates varies in the range of 16-78% in real practice and 54-88% in RCT. The persistence rate for parenteral bisphosphonates at 12 months was 86% in one real practice study, and 95% in one RCT. CONCLUSIONS: Methodology of evaluating compliance/adherence or persistence is heterogeneous among the studies of bisphosphonates treatment in patients with osteoporosis. Сompliance and persistence with bisphosphonates are poor and suboptimal in real practice. The parenteral administration of bisphosphonates seems to have enhanced adherence when compared with oral bisphosphonates.