Abstract Summary Vertebral fracture assessment (VFA) is cost-effective when it was incorporated in the routine screening for osteoporosis in community-dwelling women aged ≥ 65 years, which support guidelines, such as the National Osteoporosis Foundation (NOF) for the diagnostic use of VFA as an important addition to fracture risk assessment. Introduction To evaluate the cost-effectiveness of VFA as a screening tool to reduce future fracture risk in US community–dwelling women aged ≥ 65 years.