OBJECTIVES: Clinical management of osteoporosis often involves different pharmacologic therapies in a sequential manner.  Real-world outcomes based on sequential treatment in Korea are lacking. Our purpose was to estimate outcomes (fractures, life years (LYs), and quality-adjusted life years [QALYs]) for post-menopausal osteoporotic (PMO) women using teriparatide followed by alendronate versus only alendronate. METHODS: A validated model of osteoporosis was used to estimate base-case outcomes in a cohort of 1,000 severe PMO women (aged 65-90; bone mineral density (BMD) T-score of -2.5 standard deviations below young adult mean; 2 prevalent fractures) with 2 years of teriparatide followed by 3 years of alendronate (TPTD2+ALN3) compared to 5 years’ alendronate (ALN5). A lifetime horizon was used; 100% therapy persistence was assumed.  Efficacy values for fracture risk reduction and health utilities were obtained from the literature. Fracture incidence rates were estimated from Korean national insurance data (HIRA 2012).  Sensitivity analyses were conducted on length of treatments and patient risk profiles. RESULTS: In the base case, compared to ALN5 the TPTD2+ALN3 cohort had fewer fractures (-174; 4329 vs. 4502), more LYs (+32; 8409 vs. 8377), and more QALYs (+74; 5252 vs. 5178).  In sensitivity analysis using worse BMD T-score of -3.0, the TPTD2+ALN3 cohort had 198 fewer fractures, and 43 and 92 more LYs and QALYs, respectively, versus ALN5.  Assuming longer treatments of 7 years of alendronate (ALN7) only and TPTD2+ALN5, the results showed 185 fewer fractures, 38 more LYs and 83 more QALYs in the TPTD2+ALN5 cohort.  In the more severe population using a BMD T-score of -3.0, TPTD2+ALN5 vs. ALN7 yielded improved outcomes in terms of fewer fractures (-224), and more LYs (+48) and QALYs (+104) for the sequential TPTD2+ALN5 cohort. CONCLUSIONS: Teriparatide followed by alendronate may lead to improved outcomes when compared to alendronate only in severe PMO women in Korea.