OBJECTIVES: The prevalence of osteoporosis fractures is anticipated to increase rapidly due to China's aging population. However, nationally representative data on inpatient hospital costs and length of stay (LOS) for osteoporosis fractures are lacking. The study was to estimate hospitalization costs, LOS, costs/day, and the co-pay burden among patients with osteoporosis fractures in China.  METHODS: Data were extracted from the China Health Insurance Research Association claim database which includes a nationwide, cross-sectional sampling of inpatients from 2008-2010. The descriptive analysis included inpatients (≥50 years) who had discharge diagnosis of fracture (vertebral, hip, non-vertebral/non-hip(NVNH), or multiple fractures) and either had a diagnosis of pathological osteoporosis or osteoporosis drug treatment. Total medical costs and LOS were calculated and compared by Wilcoxon test within subgroups.  RESULTS: The analysis included 830 patients (female:77.4%, mean age:73.4 years). The medians of overall LOS and total costs were 19 days and 18587.0 RMB. Patients≥70 years (n=581) had greater LOS and costs than patients <70 years (median: 19 vs. 17 days, p<0.01; 21527.6 vs. 14748.6 RMB, p<0.01). Cost/day in 2008 was 801.9±861.9 RMB, which increased  by 74.3% in 2009 and 89.2% in 2010. Hip fractures had the longest LOS (22 days) and highest cost (32593.8 RMB); and were significantly greater than NVNH fracture (18 days, p<0.01; 17185.0 RMB, p<0.01). Reimbursement of costs by basic health insurance in 2008, 2009 and 2010 was 51.8%, 54.7%, and 60.8%, respectively; while the corresponding patient co-pay burden was 48.2%, 45.3% and 39.2%.   CONCLUSIONS: The study suggests the economic burden of osteoporosis fractures is substantial in terms of LOS and inpatient costs and elderly fracture patients consume significantly more resources. Patient co-pay rates decreased due to an increase in the reimbursement rates from healthcare. The rising trend in osteoporosis fractures may pose a huge burden to China.