OBJECTIVES: Skeletal-related events (SREs) defined as pathologic fracture, radiation to bone, surgery to bone and spinal cord compression, are common consequences of bone metastasis. Prior studies have shown that SREs increase the utilization of healthcare resources, including hospitalizations. We estimated the decrease in hospitalizations when a novel superior therapy is used (denosumab), in substitution of zoledronic acid (zol), to treat patients with bone metastases secondary to breast cancer in Germany.  METHODS: An analysis was run for predicting the number of SREs avoided and the reduction in number of hospitalizations attributable to treatment with denosumab. The number of breast cancer patients was collected from a German registry using the International Classification of Disease codes. Epidemiological data were then utilized to derive the number of hospitalizations due to bone metastases. The number of patients treated for SREs prevention was obtained from market research and applied to either treatment. The total number of SREs observed was based in the SREs rates seen in a phase 3 clinical trial. German data from a multinational retrospective chart review was used to quantify the inpatient hospitalization rates and length of stay associated with each type of SRE.  RESULTS: Approximately 9,500 patients per year with breast cancer and bone metastases were estimated to be treated with denosumab or zol in Germany. The resulting 2,100 SREs prevented per year led to a reduction of approximately 700 hospitalizations per year.  The total number of days per inpatient stay avoided by using denosumab instead of zol was approximately 5,000 per year.   CONCLUSIONS: The superior efficacy of denosumab compared to zol reduces the disease burden by decreasing the number of SREs and consequently the number of hospitalizations and inpatient days.