OBJECTIVES: On the basis of current international prevalence, it can be estimated that approximately 740,000 of people in Austria over 50 years are affected by osteoporosis, of whom around 617,000 are women. With a fracture rate of 19.7 fractures per year per 10,000 inhabitants over the age of 65 years, Austria lies within the peak for Europe. Within the framework of a burden of illness study we examined the financial burden of osteoporosis in Austria.  METHODS: We took both direct and indirect costs into consideration. Direct costs encompass medical costs such as expenses for pharmaceuticals, inpatient and outpatient medical care costs, as well as other medical services (e.g., occupational therapies). Non medical direct costs include transportation costs and medical devices (e.g., wheel chairs or crutches). Indirect costs refer to costs of productivity losses due to absence of work. Moreover, we included costs for early retirement and opportunity costs of informal care provided by family members. While there exist similar studies for other countries (e.g., Germany), this is the first comprehensive study for Austria. For our analysis, we combined data of both, official statistics, expert estimates as well as unique patient surveys that are currently conducted in the course of an international osteoporotic fracture study in Austria.  RESULTS: Our estimation of the total annual costs in the year 2008 imposed by osteoporosis in Austria is €470 million. The largest fraction of this amount is incurred by acute hospital treatment. Another significant figure, accounting for 20% of total costs, is the opportunity cost of informal care.  CONCLUSIONS: The financial burden of osteoporosis in Austria is substantial. Economic evaluations of preventive and therapeutic interventions for the specific context of Austria are needed to inform health policy decision makers.