OBJECTIVES: To evaluate direct medical costs of treatment for osteoporotic fractures in Slovenia and Serbia from a public payer and patient perspective directly after fracture and up to 1 year follow-up. METHODS:   A medical chart review, examining medical resources used to treat the 3 most common osteoporotic fractures (proximal femur, vertebral and distal radius) in the first year after the event. Collection of data from 1 osteoporotic center in Slovenia and 3 in Serbia was carried out by local investigators between December 2009 and March 2010. The treatment costs for each fracture type from the public payer and patient perspective were calculated. The analysis was divided into 2 parts: intervention directly after the fracture (including cost of hospitalization, ambulatory visits, procedures, examinations, and medications) and follow-up for up to 1 year after the event (including costs of hospitalization, outpatient visits, examinations, rehabilitation, medications and devices). RESULTS: A total of 240 patients aged >50 years with low-trauma fractures occurring within 5 years before study initiation were included. Average annual costs of treatment of a proximal femur fracture in Slovenia were estimated at €4727 (costs directly after fracture = €4088 and follow-up period = €639) and in Serbia €3002 (€2359 and €642, respectively). The cost of treatment of a vertebral fracture was €4319 in Slovenia (€3762 and €557, respectively) and in Serbia €390 (€103 and €287, respectively). Treatment of the distal radius fracture was €1567  in Slovenia (€1046 and €521, respectively) and in Serbia €163  (€57 and €106, respectively). CONCLUSIONS: Treatment of proximal femur fractures vs vertebral and distal radius fractures generated the highest costs. The treatment costs were significantly higher in Slovenia compared with Serbia. Large disparities between the costs of hospitalization in both countries were the major reason for the observed differences.