Abstract

Background/Purpose: Cardiovascular Disease (CVD) and osteoporosis are leading contributors to morbidity, mortality, and healthcare expenditures. While CVD Has a much larger population and dominates total spending, osteoporosis-related fractures, especially hip fractures impose a larger substantial expense per-event and long-term costs. This study compares the economic burden, cost drivers, and prevention value of these conditions, with emphasis on gaps in osteoporosis care delivery.
Methods: A narrative economic analysis was conducted using published U.S. cost data, cost-effectiveness studies, and implementation metrics for CVD and osteoporosis. Outcomes included total annual costs, per-event costs, cost-effectiveness of preventive interventions, and real-world treatment rates following sentinel clinical events. The effects of the Women’s Health Initiative (WHI) and the Dual-Energy X-Ray Absorptiometry (DXA) pricing were incorporated.
Using the 2015 to March 2020 National Health and Nutrition Examination Survey and 2015 to 2019 Medical Expenditure Panel Survey, this data indicates the estimated trends in prevalence for cardiovascular risk factors based on American Heart Association (AHA) adverse levels of Life’s Essential 8 and clinical cardiovascular disease and stroke. It is projected for both contributors through 2050, overall and by age and race and ethnicity, accounting for changes in disease prevalence and demographics. The Cochrane Systemic Review also participated in some of the analyses.
Results: Government cutbacks on bone density readings include a professional component paying only $37 for non-facility bone density studies and the impact of the Women’s Health Initiative had a detrimental effect on osteoporosis and fractures. Annual costs for CVD exceed $500 billion, compared with approximately $57 billion for osteoporosis-related fractures. However, per-event costs for hip fracture ($47,000-$71,000) equal or exceed those for myocardial infarction ($18,000-$29,000) and stroke ($15,000-$34,000). Hip fractures account for approximately 72% of osteoporosis-related costs despite representing a minority of fractures. Both diseases demonstrate high-value preventive interventions: statins and smoking cessation in CVD; DXA underpayment, anabolic and non-anabolic therapy and Fracture Liaison Services (FLS) in osteoporosis. Anabolic therapy, which is more effective but more expensive should also be included. Fracture Liaison Service (FLS) is cost-saving, with estimated savings of $418 per patient and $418 million per 1 million Medicare beneficiaries treated, preventing approximately 30,000 fractures. Despite this, implementation differs markedly: >90% of CVD patients receive secondary prevention after myocardial infarction, whereas <20% of patients receive osteoporosis treatment following hip fracture, but only ≈9% treated within 6 months.
Conclusion: Correcting underpayment and availability of bone DXA studies and understanding how incorrect interpretation of the WHI led to a higher risk of fractures. Although CVD carries a greater total economic burden, osteoporosis demonstrates comparable of greater cost intensity per clinical event and possible but not obtained highly favorable prevention economics. The persistent post-fracture treatment gap represents a major systems failure. FLS offers a scalable, cost-saving intervention that improves outcomes and reduces downstream costs. Aligning osteoporosis care with established CVD prevention frameworks represents a critical opportunity for value-based healthcare improvement.

Keywords:Osteoporosis; Fragility fracture; DXA; Cardiovascular disease; Cost-effectiveness; Fracture liaison service; Value-based care