OBJECTIVES: Purposes of this study are to evaluate value for money of providing screening for osteoporosis among postmenopausal women aged more than 45 years with no prior history of hip and vertebral fractures, and prevention of the fractures among osteoporosis women in Thailand. The screening modalities include: 1) a systematic screening using Dual energy X-ray absorptiometry (DEXA): 2) a systematic screening using the osteoporosis self-assessment tool (OST) at first, then DEXA for selected groups; and 3) no screening. The treatment options comprise alendronate, risedronate, raloxifene, calcitonin nasal spray and “do-nothing” strategy for prevention of osteoporotic fractures. METHODS: Cost-utility analyses were conducted using both health care provider’s and societal perspective. Decision tree model was constructed for analysis of the screening program while the markov model was applied to compare costs and effectiveness between treatment options. Most input parameters were obtained from systematic reviews and meta-analysis from published literature. The service costs and related household expenses were based on the Thai setting. Probabilistic sensitivity analysis was used to incorporate the impact of parameter uncertainty. RESULTS: DEXA was the most preferable option for screening. The cost per Quality Adjusted Life Year (QALY) gained was lower for older women except the aged of 75 years or more. Comparing between treatment options, alendronate provided the lowest cost-effectiveness ratio while calcitonin nasal spray presents the highest cost-effectiveness ratio for both perspectives. CONCLUSIONS: Given the willingness to pay per QALY at 3 times of Gross Domestic Product per capita (BAHT360,108), providing a systematic DEXA screening and alendronate at the aged more than 60 years old present a good value for money. These findings were eventually used for considering the inclusion of osteporosis drugs in the National Essential Drug List in Thailand.