OBJECTIVES:   The goal of this study was to estimate the cost-effectiveness of strontium ranelate in the treatment of postmenopausal osteoporotic women in Turkey. METHODS:   A validated Markov microsimulation model with a Turkish payer's perspective estimated the cost per quality-adjusted life-year (QALY) of strontium ranelate treatment compared with risedronate, raloxifene, ibandronate, alendronate and calcitonin.  Markov Model was used and applied in the Treeage Pro software over a cohort of 1000 patients in the pharmacoeconomical analysis. As for the sensitivity analysis, the Monte Carlo Simulation was used, applying a simulation of 10.000. Data on the effect of both treatments on fracture risk were taken from the literature. The cost of the treatments were calculated based on Turkish reimbursement systems, the indirect and intangible costs were omitted. The direct disease costs include the amount spent for the costs associated with the outpatient, inpatient, medical supplies, all the laboratory or imaging tests and the interventions performed. The costs of the side effects were added to all the drug costs. The official product summaries were used for detecting the side effects of the products. RESULTS: Strontium Ranelate provides the highest gain of quality life years and is the superlative therapeutical choice with respect to QALY.  According to it’s cost and effectiveness value, strontium ranelate was dominant (i.e. more effective and less costly) versus ibandronate and calcitonine for postmenopausal osteoporotic women . The cost per QALY gained by  strontium ranelate compared to ibandronate was € 5582 and calcitonine was € 3943. Compared to alendronate, risedronate and raloxifene, strontium ranelate was cost effective (i.e. more costly but more effective). CONCLUSIONS: The results of this study suggest that strontium ranelate is a cost-effective strategy, in a Turkish setting, for the treatment of postmenopausal osteoporotic women.