OBJECTIVES: Comparing bone-related event treatment costs in a Latin America country private health care provider. Background: The rising costs of prostheses and orthopedic curative or palliative procedures in oncology patients, and pathological fractures due to osteoporosis stimulate the innovation of using drugs, such as bisphosphonates, intended to minimize skeletal-related events. Little is known about the economic impact of these measures. METHODS:  We analyzed the electronic medical records of 100 patients (GROUP A) who received zoledronate ( zol ) at some point during their treatment (2009 – 2014). Most (71 patients) were diagnosed with breast cancer. The others 29 were diagnosed with other types of cancer. We analyzed another group of 88 patients (Group B) who had osteoporosis vertebral fracture with or without surgery procedure RESULTS: The costs for Group A were estimated at approximately R$ 876.000,00 Brazilian reals (~ USD 437.000,00 ) with 487 IV applications of zol during five years considering only bottle/vials spending. Expenses with femur and column prosthesis totaled $455,000.00 and $580,000.00 USD respectively, if all 100 patients should spent in prosthesis . For both groups the data regarding costs was calculated based on the pharmacoecomic model. If all 88 patients were treated with an external prostheses using a non–pharmacological (SPINOMED) treatment for vertebral fracture, the cost would be roughly € 35.200 Euros (88 patients x 400 Euros), that is ~$70.400.00 USD or ~R$176.000 ,00 Brazilian Reals. CONCLUSIONS: In spite of different clinical aspects of evaluation, due to biologic heterogeneous disease, the use of IV zol in group A patients was favorable and further studies investigating others patterns such as microscopic bone pathology and pharmacologic exposures should be conducted . The non pharmacological treatment is cost effective in group B due to the results based on the total costs.