OBJECTIVE: To systematically review the efficacy and safety of denosumab injection versus zoledronic acid injection in the treatment of postmenopausal osteoporosis, so as to explore the economics by cost-effectiveness method. METHODS: Chinese databases such as CNKI, CBM, Wanfang Data, and VIP and English databases such as PubMed, Embase and the Cochrane Library were retrieved to collect the randomized controlled trial of denosumab injection versus zoledronic acid injection in the treatment of postmenopausal osteoporosis (study group was treated with denosumab injection, control group was given zoledronic acid injection). The retrieval time was from the establishment of the database to May 2022. After literature screening and data analysis, efficacy of the two regimens was analyzed by Meta-analysis. Cost-effectiveness analysis was used to compare the economics of the two regimens from the perspective of health care system. RESULTS: Totally 3 studies were enrolled, including 1 163 patients. Meta-analysis showed that compared with zoledronic acid injection, desuzumab injection could significantly improve the percentage change of bone mineral density of lumbar spine and hip bone in postmenopausal osteoporosis ( lumbar spine: MD = 1. 07,95% CI = 0. 23-1. 91,P = 0. 01; hip: MD = 0. 89,95%CI = 0. 13-1. 65,P = 0. 02), with statistically significant difference; yet did not significantly reduce the risk of fracture(OR = 0. 52,95%CI = 0. 23-1. 17,P = 0. 11),and the difference was not statistically significant. In terms of safety, the incidence of adverse drug reactions in both regimens was low, and no particularly severe adverse drug reactions occurred. Cost-effectiveness analysis showed that the cost-effectiveness ratio of dizumab injection was lower than that of zoledronic acid injection ( 492. 03 vs. 834. 34 ). CONCLUSIONS: Desumumab is superior to zoledronic acid in increasing bone mineral density in the treatment of postmenopausa [ABSTRACT FROM AUTHOR]