Objectives: The use of immunosuppressive agents, especially glucocorticoids, are associated with increased risks of bone loss in kidney transplant recipients (KTRs). Denosumab, a potent antiresorptive agent, has been shown to increase bone mineral density (BMD), but the clinical efficacy and safety of denosumab on osteoporosis in KTRs remain unclear. Methods: We analyzed 69 KTRs who used denosumab at Keimyung University Dongsan Hospital from 2018 to 2021. We investigated the change of BMD, calcium, phosphorus, parathyroid hormone (PTH), vitamin D, allograft function, tacrolimus trough level (TTL), complications of denosumab, acute rejection within 1 year and graft failure and death. Results: The mean T-scores at 1-year post-denosumab were significantly increased comparing to the mean T-scores before denosumab at the femur neck and spine area, respectively (-2.76±0.55 vs. -2.87±0.56, P=0.015; -2.64±1.08 vs. -3.11±1.08, P=0.003). The levels of calcium, phosphorus, and creatinine were significantly decreased and those of PTH and vitamin D were significantly increased at 1-year after denosumab, but there was no significant difference in the TTL. Only 2 KTRs had a new fracture despite 10 KTRs with the history of fracture. T-scores on BMD were significantly associated with fracture risk assessment tool (FRAX) score and FRAX score was significantly decreased after denosumab. Urinary tract infection (UTI) was 17.4%, but there was no significant hypocalcemia. Acute kidney injury, cardiovascular disease, and arthralgia occurred in 1 case each. Acute rejection within 1 year was 4.3% and there were no graft failure and death. Conclusions: The use of denosumab in KTRs is effective and safe for the treatment of osteoporosis, but it should be carefully monitored for UTI.