OBJECTIVES: Osteoporotic fractures are common in older adults and are often associated with high morbidity and mortality.  As the incidence increases with age, it  is natural  that osteoporotic fractures  have become a major health problem worldwide. Increasing number of patients with osteoporotic fracture  will have a serious economic impact on the patient themselves and the society. The objective of this study is to  study the cost-effectiveness of strontium ranelate compared to alendronate for patients with post-menopausal osteoporotic fractures in Malaysia. METHODS: A Markov model was developed to project clinical and economic benefits of strontium in a hypothetical cohort of patients (N=1,000) over a 5-year time horizon. This study was conducted from a payer perspective. Model parameters including transition probabilities and costs of treating fracture at various sites were Malaysia-specific.  Drug costs were obtained from a public teaching hospital in Kuala Lumpur. Utilities were derived from previous literatures and efficacy data were derived from two pivotal trials, i.e. SOTI and TROPOS trials. Outcomes were presented as cost per quality-adjusted life year (QALY) gained. A discount rate of 3% was applied. Both 1-way and multivariate probabilistic sensitivity analyses were undertaken to evaluate robustness of results. RESULTS: Compared to alendronate, strontium could prevent 328 wrist, 192 hip, 7 vertebra and 115 multiple fractures respectively over 5 years, which was translated into 27.9 QALYs gained. Using strontium can lead to cost reduction of MYR1,416,595(USD442,685), MYR478,257(USD149,455), MYR22,784(USD7,120) and MYR61,883(USD113,088) due to reduced episodes of fractures at wrist/hip/vertebra/multiple sites respectively. The total reduction of direct medical costs of MYR2,279,519(USD712,349) was larger than the extra drug cost , hence making strontium a cost-saving therapy. CONCLUSIONS: It was shown that strontium appeared to be more cost-effective compared to alendronate and hence should be recommended in the public sector in Malaysia.