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Objective China has a high disease burden of low bone mass, and elderly men with excessive alcohol consumption may be underdiagnosed and undertreated given the adverse effects on skeletal health. This study implemented an economic evaluation to assess the screening plus receiving anti-osteoporotic medication for low bone mass prevention in older men with excessive alcohol intake.Design and setting A patient-level Markov model.Participants Chinese men aged over 60 years with excessive alcohol consumption.Interventions Receiving screening plus medication considered with two eligibility strategies for therapy: osteoporosis and osteopenia.Outcomes The quality-adjusted life-years (QALYs), lifetime cost and the incremental cost-effectiveness ratio (ICER) were calculated for different strategies relative to no screening. Scenario analyses were conducted to evaluate the cost-effectiveness associated with risk factors, study perspectives and selection of medication.Results From the healthcare perspective, the prevention strategies for men aged over 70 years were cost-effective with the ICER of $28 403/QALY for osteoporosis and $24 560/QALY for osteopenia. Scenario analyses revealed screening strategies were cost-effective in men with risk factors aged over 60 years. In the selection of medication, denosumab might be dominant. From the societal perspective, prevention for osteopenia aged from 60 years was cost-effective at the ICER of $36 524/QALY.Conclusions These findings suggest that prevention strategies for Chinese older men with excessive alcohol consumption would be cost-effective. Early screening initiation will aid efforts in improving skeletal health for men with excessive alcohol intake in China and reducing humanistic and economic burdens.