OBJECTIVES:: The aim of this study was to assess the cost and health effects of teriparatide in women and men with severe osteoporosis (OP) and high risk of Fragility Fractures (FF) from the public health perspective (SeguroPopular/ISSSTE). METHODS:: Target population was patients aged ≥50 years, with OP and high risk of FF, T-score ≤ 4.0, three clinical risk factors, with recent vertebral fracture not candidates to receive bisphosphonates. Daily subcutaneous injection of teriparatide 20mcg for maximum treatment duration of 18 months was analyzed considering cost-benefit based on the clinical benefit and treatment budget impact. The clinical benefit was represented by a decrease in the risk of new fractures due to osteoporosis fragility, which in turn reduces the economic and social impact they cause, including the negative effect on disability and premature mortality, with a 6-year time horizon. The incidence of FF was obtained from the FRAX® algorithms for Mexican patients. Efficacy data were gathered from placebo-controlled clinical trials of teriparatide. We analyzed acquisition costs of teriparatide and medical care and indirect costs due to FF. Frequency, location of fractures and the years of healthy life expectancy were estimated. The final outcome is reported as the net monetary benefit (NMB) in each institution. RESULTS::  According to the General Direction on Health Information database, approximately 10,323 patients (SP: 6,479/ISSSTE: 3,844) have suffered FF in 2015. It was assumed only 20% of patients received treatment in SP and 60% in ISSSTE. A timely intervention for the target population in SP/ISSSTE, would reduce the number of FF 48%, and the loss of health life expectancy by 45%/44%, respectively, becoming cost effective allowing a NMB of 10.8/20.1 million (MXN), respectively. CONCLUSIONS::  Teriparatide has a positive NMB and should be considered as an option in the treatment of severe osteoporosis.