OBJECTIVES: To estimate annual health care resource utilization and direct medical cost for patients with osteoporotic fractures in Tianjin, China. METHODS: Data were obtained from Tianjin Urban Employee Basic Medical Insurance database. Patients who ≥50 years old, with ≥1 diagnosed of osteoporotic fractures between 2009 and 2010, and 12-month continuous enrollment before (baseline) and after (follow-up) the first observed osteoporotic fracture diagnosis were identified. Both osteoporosis-related and all-cause health care resource utilization and direct medical cost were estimated during the 12-month follow-up period. Ordinary least square regression model was applied to identify factors associated with the direct medical cost. RESULTS: A total of 5941 patients were included, with mean age of 65.9 (±10.5) years, 62.1% female, and 88.2% retired. Annual mean all-cause cost was $2,466 per patient with osteoporosis-related cost accounting for 53.8%. For osteoporosis-related health services, 33.2% of patients experienced ≥1 hospitalization with mean length of stay of 18.0 (±14.4) days and mean cost of $2,913 per admission, and 83.2% of patients experienced ≥1 outpatient visit with mean (±SD) number of visits 7.4 (±8.7) and mean cost $17 per visit. The medical device cost was the largest component (38.5%) of osteoporosis-related cost, followed by drug cost (31.1%) and examination cost (11.7%). The regression model revealed that osteoporosis-related cost tended to increase with age, patients with hip, vertebral, lower leg and multiple fractures were more likely to have a higher cost. CONCLUSIONS: Costs for patients with osteoporotic fractures were considerable in Tianjin China, driven mainly by osteoporosis-related hospitalizations. Efforts focused on reducing the utilization of inpatient services and increasing efforts to lower the fracture risks may have the potential to lighten the economic burden of osteoporotic fractures in China.