OBJECTIVES: Multiple pharmacological alternatives are available for treatment and prevention of osteoporosis. In spite of the cost of alternatives, studies assessing the price of drugs used in osteoporosis are lacking. This study provides an analysis of the prices of osteoporosis drugs marketed in the US in the period 1988-2014, assesses price differences between brand and generic drugs, compares different drug prices available in the market, and evaluates trends in prices before and after generic entry. METHODS: Data were derived from the U.S Food and Drug Administration (FDA), the RedBook (Truven Health Analytics), the Centers for Medicare & Medicaid Services (CMS), and the Federal Supply Schedule (FSS). Descriptive statistics and segmented linear regression analyses were performed in the study. RESULTS: Osteoporosis drug prices increased faster than the inflation. The average wholesale price (AWP) of generic products at market entry typically represented around 90% of the AWP for the corresponding brand products. Prices of brand products continued to increase after generic entry. Drug prices showed a large variation when compared with the brand AWP. The brand wholesale acquisition cost (WAC) was typically set at 83.3% of the AWP. Community pharmacies (independent and chains) acquires osteoporosis brand drugs at a median of 80.5% of the brand AWP.  Reductions in brand AWP were observed for and Medicare Part B (78.5% of the brand AWP), generic FFS (22.5%), Federal Upper Limit (FUL) (9.8%), average manufacturer price (5.6%), CONCLUSIONS: This study found substantial differences in the manufacturer prices, acquisition estimated costs and reimbursement prices used for osteoporosis drugs in the US. Prices paid by the federal government were substantially lower than the prices paid by the private sector.