Prior national cost estimates of osteoporosis and fractures in the USA have been based on diverse sets of provider data or selected commercial insurance claims. Based on a random population-based sample of older adults, the US medical cost of osteoporosis and fractures is estimated at 22billionin2008.IntroductionNationalcostestimatesofosteoporosisandfracturesintheUSAhavebeenbasedondiversesetsofproviderdataorselectedcommercialinsuranceclaims.Wesoughttocharacterizeprevalenceandcostsforosteoporosisusingarandompopulation-basedsampleofolderadults.MethodsAcross-sectionalestimateofmedicalcostwasmadewith2002datafromtheMedicareCurrentBeneficiarySurvey(MCBS).MCBScombineshealthinterviewswithclaimsinformationfromallpayerstoprofilearandomsampleof12,700Medicarerecipients.Threecohortsaged65oroverweredefined:(1)patientsexperiencingafracture-relatedclaimin2002;(2)patientswithadiagnosis,medication,orself-reportforosteoporosisorpasthipfracture;and(3)non-casecontrols.Thetotalcostofpatientclaimswascomparedtothatofcontrolsusingmultipleregression.ResultsOf30.2millionelderlyMedicarerecipientsin2002,1.6million(5%)weretreatedforafracturethatyear,andanadditional7.2million(24%)haveosteoporosiswithoutafracture.Theestimatedmeanimpactoffracturesonannualmedicalcostwas 8,600 (95% confidence interval, 6,400to 10,800), implying a US cost of 14billion( 10 to 17billion).Halfofthenon-fractureosteoporosispatientsreceiveddrugtreatment,averaging 500 per treated patient, or 2billionnationwide.ConclusionsTheannualcostofosteoporosisandfracturesintheUSelderlywasestimatedat 16 billion, using a national 2002 population-based sample. This amount corroborates previous estimates based on substantially different methodologies. Projected to 2008, the national cost of osteoporosis and fractures was 22billion.