OBJECTIVES: Glucocorticoid therapy is associated with an appreciable risk of bone loss, eventually leads to increased fracture events. Osteoporosis-related fractures, especially of the hip, are associated with morbidity and mortality, reducing one’s quality of life. This study aims to evaluate the cost-effectiveness of bisphosphonates for prevention of glucocorticoid-induced osteoporosis (GIOP) in Malaysia.  METHODS: Retrospective data of effectiveness and cost were collected from medical and billing records of the Universiti Kebangsaan Malaysia Medical Centre between January 2013 and December 2014. Actual fracture events and bone mineral density (BMD) values were assessed as primary and secondary outcomes of anti-osteoporotic therapy. RESULTS: Majority of the studied patients (n=47) experienced a hip (n=19) or spine (n=19) fracture, and two patients experienced both hip and spine fractures. Fracture events was significantly associated (χ(3)=17.420, p=0.001) with  factors such as age (Wald (1)=5.979, p<0.005), and number of clinical risk factors (Wald (1)=10.813, p<0.005), while femoral bone mineral density (BMD) (Wald (1)=2.602, p>0.005) was not statistically significant. Average cost of hip fracture per patient was MYR21,771.86±20,579.25 (US$15,140.38±14,311.02). Commencement of bisphosphonates at 65 years old was more cost-effective, with the incremental cost-effectiveness ratio (ICER) of MYR 24,588.47/hip fracture prevented (US$17,099.08) compared to the ICER of MYR 96,136.47 (US$66,854.29) in all population. Bisphosphonates is a ‘dominant’ cost-effective alternative for secondary prevention of fractures. CONCLUSIONS: Bisphosphonates is potentially a cost effective treatment for GIOP, especially if started before 65 years old. It also has the potential to be cost-effective for secondary prevention of fracture in Malaysian population. Larger study with more patients and longer duration is needed to confirm our findings and provide more accurate information for rational and economical management of GIOP.