OBJECTIVES: Osteoporosis is a prevalent disease, characterized by low bone mass and increased fracture risk.  In 1993 the economic burden of osteoporosis-related fractures in Canada was $1.3 billion dollars, of which $437 million was acute care.  Our objective was to update the1993 acute care estimates for Canada for non-traumatic fractures.    METHODS: We used national administrative databases from Canadian Institute for Health Information for fiscal-year ending March 31, 2008 for Canadians over age 50. Data sources included the Discharge Abstract Database for all acute care hospitalizations in Canada except Quebec; National Ambulatory Care Reporting System for all same day surgery, emergency visits/ambulatory services in hospital for Ontario.  Both data sources were projected nationally using Statistics Canada census data.  Non traumatic fractures included hip, humerus, vertebral, wrist, other sites (ribs/sternum, pelvis, trunk, clavicle, scapula, femur, patella, tibia/fibula), and multiple sites (more than 1 of the preceding). Costs were based on resource intensity weights for direct medical costs less physician billings. Physician fees billed directly to provincial plans included visits in hospital, diagnostic and surgical interventions. RESULTS: Osteoporotic non-traumatic fractures were responsible for 57,404 acute care admissions, 112,749 emergency room visits, and 3,433 same day surgeries in Canada in 2008. Hip fractures accounted for 50.3% of admissions, wrist fractures accounted for 80.8% of same day surgeries, and emergency visits mostly occurred in other sites (30.0%), wrist (29.7%) and hip fractures (22.9%). The cost of acute care was estimated at $1.2 billion with hip fractures alone costing $619 million.   CONCLUSIONS: Osteoporosis is a chronic disease that affects a large segment of the adult population in Canada and increases the risk for expensive health care utilization for Canadians. Since 1993, the acute care cost of osteoporosis-related fractures has risen from $437 million to $1.2 billion dollars per year, which represents an increasing economic burden for Canada.