OBJECTIVES: Osteoporotic Fractures (OF) in elderly people are common worldwide, and the predicted aging of populations is increasing the burden of OF on health care systems. This study estimates the economic burden of OF in aged 65 years and over in South Korea from a societal perspective. METHODS: National health insurance claim databases were used to analyze annual health care utilization and medical costs of OF in the South Korean population (49.78 million). We identified medical claims records for elderly people with a diagnosis of OF and estimated the costs by a macro-costing method from 2007 to 2011. RESULTS: From 2007 to 2011, there were 244,798 elderly patients with at least 1 medical insurance claim related to OF. Most patients had a single fracture (83%), while 17% of all patients had two or more. By fracture site, vertebral fracture accounted for 76.3% of all fractures, followed by 9.9% for hip fracture and 7.5% for wrist fracture. The societal cost of OF increased annually, from $83.7 million in 2007 to $141.4 million in 2011. For the societal cost of OF, direct medical cost was $134.9 million in 2011, which includes cost of treatment ($88.3 million) and long-term care ($46.6 million). The direct non-medical cost (transportation and caregiver costs) was estimated at $6.5 million in 2011. Costs associated with morbidity and mortality of OF were excluded due to the characteristics of the patients such as age, disability level and age at death.  CONCLUSIONS: The results of this study indicate that the economic burden associated with OF in elderly people in Korea is considerable and is expected to rise with the predicted increases in life expectancy and the number of elderly in South Korea. Therefore, effective management of the disease is necessary to reduce the growth in the economic burden of OF.