The economic benefits of fracture prevention

INTRODUCTION: Osteoporosis-related fractures represent a significant and growing public health concern, especially in aging populations. Despite the availability of effective treatments, significant care gaps persist in both primary and secondary prevention. AREAS COVERED: This narrative review synthesizes key findings from economic evaluations examining the cost-effectiveness of pharmacological and non-pharmacological therapies, fracture liaison services (FLS), and FRAX®-based intervention thresholds. Relevant literature was reviewed, including systematic reviews, country specific studies, and emerging data on novel technologies. The evidence consistently demonstrates that fracture prevention strategies are cost-effective across diverse healthcare settings. Pharmacological monotherapy and sequential regimens have shown favorable economic profiles, while FLS programs, although resource-intensive, significantly reduce re-fracture rates and associated costs. Intervention thresholds should be derived clinically, with health economic modeling used to evaluate their cost-effectiveness so as to guide rational, risk-based treatment strategies. EXPERT OPINION: Health economic evaluations are increasingly enabling the development of osteoporosis treatment strategies, highlighting the strong cost-effectiveness potential of these interventions. However, challenges remain including heterogeneity in analytical approaches, under-representation of low- and middle-income countries, and limited incorporation of real-world (adherence) data. Maintaining methodological consistency, expanding region-specific data, and evaluating emerging technologies with robust economic frameworks are essential steps toward achieving globally equitable and cost-effective osteoporosis care.