OBJECTIVES: To identify and compare the cost-effectiveness of raloxifene, alendronate and nasal calcitonin in the treatment of osteoporosis in postmenopausal women in Poland. METHODS: Model for the Polish health-care context was developed, based on the use of clinical data from literature and local data of health-care resource utilisation and unit cost. Only the direct medical costs were analysed. The perspective of health-care payers and time horizon of 3 years was considered. The target population were patients aged 68, without (group I) and with or without (group II) previous vertebral fractures. The outcomes measures were LYG and QALYs gained, calculated on the basis of available evidence for a preventive effect on a hip, vertebral, wrist and ankle fractures and breast cancer risk. The cost-effectiveness threshold was calculated on the basis of 1-year haemodialysis treatment cost (60 000 PLN, 1 USD=4 PLN; in 2002). The one-way and two-way sensitivity analysis was performed. RESULTS: The highest effectiveness in terms of LYG and QALYs was achieved with raloxifene treatment compared to alendronate and calcitonin. Calcitonin was the least effective and the most costly strategy. Incremental analysis suggests that raloxifene compared with alendronate gives additional effects for extra costs below suggested cost-effectiveness threshold: the ICER was 35023 PLN/LYG and 31023 PLN/QALY gained in group I, and 45834 PLN/LYG and 40571 PLN/QALY gained in group II. Sensitivity analysis showed that calcitonin remained dominated strategy by comparators in all cases. Only raloxifene price and incidence of breast cancer changes have significant effect on the ICER, placing it above the cost-effectiveness threshold. CONCLUSIONS: Given the results of the analysis, in postmenopausal women calcitonin is less effective and more costly than alendronate and raloxifene. Based on current evidence, raloxifene appears to be cost-effective when compared with alendronate and within a Polish context offers substantial benefit at reasonable cost.