OBJECTIVES: Aging of the Chinese population will result in so many at risk of osteoporosis that economically efficient approaches to treat osteoporosis warrant consideration. This study evaluated the cost-effectiveness of osteoporosis treatment on senior Chinese women population. METHODS: A discrete event simulation model using age specific probabilities of hip fracture, clinical vertebral fracture, wrist fracture, humerus fracture, other fracture, costs (2015 US dollars), and quality-adjusted life years (QALYs) was used to assess the cost-effectiveness of osteoporosis treatment. Incremental cost-effectiveness ratio (ICER) was calculated. The willingness-to-pay (WTP) for a QALY in China was compared with the calculated ICER to decide the cost-effectiveness. To determine the absolute10-year hip fracture probability at which the osteoporosis treatment became cost-effective, average age-specific probabilities for all fractures were multiplied by a relative risk (RR) that was systematically varied from 0 to 10 until the WTP threshold was observed for treatment relative to no intervention. Sensitivity analyses were also performed to evaluate the impacts from WTP and annual treatment costs. RESULTS: In baseline analysis, simulated ICERs were higher than WTP threshold among Chinese women younger than 75, but much lower than WTP among the older population.  Sensitivity analyses indicated that cost-effectiveness could vary due to a higher willingness-to-pay (WTP) threshold or a lower annual treatment costs. A 30% increase in WTP or a 30% reduction in annual treatment costs will make osteoporosis treatment cost-effective for Chinese women population from 55 to 85.  CONCLUSIONS: Current study provides evidence that osteoporosis treatment is cost-effective among a subpopulation of Chinese senior women. The results also indicate that the cost-effectiveness of using osteoporosis treatment is sensitive to the WTP threshold and annual treatment costs.