OBJECTIVES: Osteoporosis mainly concerns postmenopausal women, may cause fractures and can be treated. The diagnosis of osteoporosis covers the evaluation of bone density. Gold standard still is the dual x-ray absorptiometry (DXA) but the qualitative ultrasound (QUS) as a non-invasive and radiation-free technology is becoming more important. This rapid health economic health technology assessment (HTA) examines the cost-effectiveness of QUS as a technique for screening and diagnosing osteoporosis and subsequently for the prevention of osteoporotic fractures. METHODS: According to the methodological recommendations for rapid health economic HTA in Germany a systematic literature search was conducted. Quantitative and qualitative information synthesis was done. The incremental cost-effectiveness of a two-step proceeding (QUS for all women as a first step; in case of a positive QUS-test a DXA is performed as a second step) compared to a one-step proceeding (all women get an examination with DXA) as well as a comparison of the one step proceeding QUS alone versus DXA alone was calculated by the authors. RESULTS: Four publications dealt with the question of the cost-effectiveness of QUS as a screening instrument in a two-step proceeding. Despite the methodological weaknesses of the studies the reported cost could be used in the calculation of the incremental cost-effectiveness ratio. Depending on the considered studies a two-step proceeding is cost-effective as long as the costs of one QUS examination lie between 31% and 51% of costs of an examination with DXA. One diagnosed case in DXA rise additional €1000 compared to QUS. It has to be considered that QUS shows a higher amount of false positive cases that subsequently will increase costs. CONCLUSION: A priorisation of a two-step or a one-step proceeding is not possible at present due to the missing data and the lack of evidence. Decision analytic models considering long-term effects are recommended.