OBJECTIVES: Cost-effectiveness of denosumab versus other treatments in MOP in > 75- year-olds in Sweden was evaluated from a third-party payer perspective. METHODS: A lifetime cohort Markov model was developed with seven health states: well, hip fracture, vertebral fracture, other osteoporotic fracture, post hip fracture, post vertebral fracture, and dead. During each cycle, patients could have a fracture, remain healthy, remain in a post fracture state or die. Background fracture risks, mortality rates, persistence rates, utilities, medical and drug costs were derived using published sources. BMD improvements have been shown to be similar across MOP and post-menopausal osteoporotic (PMO) populations; therefore in the absence of well-powered trials evaluating fracture risk reduction in MOP, efficacy was obtained from studies in PMO women. Lifetime expected costs and quality-adjusted life-years (QALYs) were estimated for denosumab, generic alendronate, generic risedronate, ibandronate, zoledronate, strontium ranelate and teriparatide. On average, patients in the model were 78 year-old men, with bone mineral density T-score≤-2.12 and prevalent vertebral fracture of 23%. In the base-case, the model assumed patients could receive treatment effects up to 5 years after discontinuation, except on teriparatide (only 2 years). Costs and QALYs were discounted at 3% annually. Extensive sensitivity analyses were conducted. RESULTS: Total lifetime costs for denosumab, alendronate, zoledronate, strontium ranelate, risedronate, ibandronate and teriparatide were €31,324, €34,834, €35,592, €35,939, €36,008, €37,211 and €38,632, respectively. Total QALYs were 5.22, 5.12, 5.15, 5.12, 5.11, 5.09 and 5.19, respectively. Denosumab dominated all treatments by having lower costs and higher QALYs. Denosumab dominated generic alendronate (next least expensive strategy) in the one-way sensitivity analyses also. The probability of denosumab being cost-effective compared to the other treatments at a threshold of €66,000/QALY was 99.0%. CONCLUSIONS: Denosumab dominated almost all comparators, including generic bisphosphonates in the Swedish MOP population > 75 years-old.