OBJECTIVES This study aims to estimate the incidence and costs of osteoporotic fractures in The Netherlands in 2010 and project them to 2030. METHODS The incidence and health care costs of fractures were derived from claims data of all healthcare insurers in The Netherlands. We obtained 5-year age- and gender-specific costs of patients with and without fractures. Cost included hospital admission, physical therapy, occupational therapy, general practitioner and medication. In order to attribute fractures to osteoporosis we used a large dataset from a general hospital that included patients with a fracture screened with Dexa scan. Future projections were based on four different scenarios: 1.demographic scenario, 2. demographic+trend in incidence scenario, 3. demographic+trend in incidence+trend in cost scenario, and 4.increased treatment scenario. RESULTS Of all registered fractures 32% could be attributed to osteoporosis. In women this percentage was larger than in men (36 versus 21 %). This resulted in an incidence for all osteoporotic fractures of 964 per 100.000 in women and 245 per 100.000 in men for 2010. Over time (2010-2030) the overall increase in incidence of osteoporotic fractures was 40% (scenario 1). The increase in hip fractures ranged from 60% (scenario 1) to 79% (scenario2). In 2010 approximately 200 million Euros was spend on treatment of osteoporotic fractures. The costs for osteoporotic fractures increased with 50% from 2010 till 2030 (scenario 1). The increase in costs for hip fractures was highest, ranging from 60% (scenario1) to 148% (scenario 3&4 combined), resulting in cost estimates in 2030 of 161 and 249 million, respectively. Prevention of osteoporotic fractures in general can lead to cost-savings of 92 million in 2030 (scenario 4 & 1 combined). CONCLUSIONS The expected high increase in incidence and costs of osteoporotic fractures calls for a wider use of prevention and treatment options.