OBJECTIVES:  Postmenopausal osteoporosis (PMO) is a disease that reduces the bone density and bone quality increasing the risk of fractures that causes disability. As such, PMO places a significant burden on health care resources. Our objective is to assess the cost utility of Denosumab vs intravenous (IV) bisphosphonates when used for the treatment of women with PMO from the perspective of Colombian health system. METHODS:  A lifetime Markov model with 8 health states was developed to assess the cost-utility of denosumab 60 mg SQ every 6 months versus zolendronate 5mg IV every 12 months and ibandronate 150mg IV every 3 months in women >72 years with a T-score >-2.5. Efficacy, resource use and treatment patterns were obtained from the literature. Direct medical cost included drug administration, hospitalization, outpatient costs, diagnostic tests, and treatment of adverse events. For all procedures, Social Security tariff (ISS+30%) were applied; and SISMED 2015 prices for drugs costs. Costs and benefits are discounted 5% per year. A probabilistic sensitivity analysis was performed for efficacy, safety, persistence, utilities and long-term care variables RESULTS:  In the base case scenario, the estimated total cost of PMO treatment was 13,695,881$COP, 13,561,562$COP, 14,248,093$COP for denosumab, zolendronate, and ibandronate IV respectively. While the estimated QALY’s gain were 7.479 for denosumab, 7.466 for zolendronate, and 7.43 for ibandronate. The estimated denosumab incremental cost-effectiveness ratio (ICER) vs zolendronate was 9,650,071$COP/QALY. Denosumab was dominant vs ibandronate. Sensitivity analyses confirmed the robustness of these findings CONCLUSIONS:  Denosumab use in the treatment of PMO in Colombia is likely to be a cost-effective alternative to zolendronate IV with an ICER less than 1 GDP per capita. Denosumab is also likely to be a cost-saving alternative to ibandronate IV.