OBJECTIVES: Over 75% of osteoporotic patients are not diagnosed with osteoporosis and do not receive treatment because effective on-site diagnostics is lacking in primary care facilities. We compare the cost-effectiveness of two pathways of osteoporosis diagnosis: 1) Fracture Risk Assessment Tool (FRAX) followed by pocket size pulse-echo ultrasound device (Bindex®) followed by Dual-energy X-ray absorptiometry (DXA) when needed (“proposed”), and 2) FRAX followed by DXA when needed (“guideline”). METHODS: A new Markov model of preventive osteoporosis treatment (assumptions: generic alendronate treatment; efficacy based on published meta-analysis and modified by compliance/persistence; wrist, vertebral, hip and other fractures included; Finnish health care payer perspective with 10-year timeframe and 3% discounting per annum) was extended to include the proposed pathway and osteoporosis screening/diagnosis in terms of sensitivity/specificity. FRAX with body mass index and age dependent National Osteoporosis Guideline Group thresholds was the initial screening tool common to both pathways. Bindex®  was calibrated to 90% sensitivity and specificity thresholds (International Society for Clinical Densitometry). In the proposed pathway, only the patients with Bindex result between these calibration thresholds (32,6% of the patients) required a DXA measurement to verify the diagnosis of osteoporosis. Cost-effectiveness was assessed in five patient cohorts: women (BMI 24 kg/m2) aged 65 years with previous fracture and 75 or 85 years with and without previous fracture. RESULTS: Among the cohorts modeled, the average screening cost saved with Bindex® including proposed pathway in comparison to current guideline pathway were around €230/patient. At a cost of €50/screen, the probability that the pathway including Bindex® was cost-effective compared to the current pathway was 100% in all patient cohorts. Bindex® including pathway appeared to be cost-effective at prices as high as €100/screen. CONCLUSIONS: Bindex® including pathway appears to be cost-saving strategy compared to the current and recommended Finnish osteoporosis diagnosis and care pathway.