OBJECTIVES: An increased risk for fractures has been observed in patients treated with opiates, possibly resulting from falls related to central nervous system effects, such as dizziness. Observational data suggest that the semisynthetic opioid, buprenorphine, may be associated with a lower fracture risk than some other opiates such as tramadol. Our objective was to perform a preliminary analysis to explore whether a buprenorphine-class drug has the potential to be cost-effective due to a reduced risk for fracture. METHODS: Decision-analytic modeling was used to project fracture-related outcomes and costs over 1 year. Quality-adjusted life-years (QALYs) and costs (in 2012 pounds sterling) were estimated from a health service perspective.  Odds ratios for forearm, hip, and spine fractures, by drug, estimated from real-world hospital discharge data (Vestergaard et al., 2006), were applied to the risk for fracture in the general population. Drug costs were based on the 10-μg per hour buprenorphine patch and the equivalent tramadol dose (2013 British National Formulary listings). Fracture costs were from a recent National Institute of Health and Care Excellence submission; utility weights were obtained from the literature. RESULTS: For a population of 100,000, the model predicted a reduction in the number of additional fractures (forearm, hip, or spine) associated with analgesic use from over 2,000 for patients treated with tramadol to under 20 for patients treated with buprenorphine. An estimated £5.5 million was saved and over 1,300 QALYs were gained. In sensitivity analysis, buprenorphine was dominant in most analyses and most sensitive to treatment duration. The cost-effectiveness estimate was below £20,000 per QALY in all scenarios. CONCLUSIONS: Our preliminary analysis suggests that buprenorphine has the potential to be dominant and cost-effective, compared with tramadol.