OBJECTIVES: To evaluate fracture-related expenses and health care resource utilization among post-menopausal women in the U.S. Medicaid population. METHODS: Female patients diagnosed with fractures (International Classification of Disease, 9^th Revision, Clinical Modification [ICD-9-CM] codes: 733.12-.16, 805.0, 805.2, 805.4, 805.6, 805.8, 808.0, 808.4, 808.8, 810.0, 812.0, 812.2, 812.4, 813.0, 813.2, 813.4, 813.8, 814.0, 820.0, 820.2, 820.8, 821.0, 821.2, 823.0, 823.2, 823.4, 823.8) were identified using U.S. Medicaid data from 01JAN2009 through 31DEC2009. The initial diagnosis date was designated as the index date. A control cohort that included patients without fractures of the same age, race, region and baseline Charlson Comorbidity Index score was created. The index date for the control cohort was randomly assigned to minimize selection bias. Patients in both cohorts were required to be age ≥50 years, with continuous medical and pharmacy benefits for 1-year pre- and post-index date. Propensity score matching (PSM) was used to compare health care costs and utilizations during the follow-up period. RESULTS: Before matching (n=80,516), fracture patients were more likely to be white (71.2% vs. 46.2%), reside in the South U.S. region (39.2% vs. 34.1%) and have chronic obstructive pulmonary disease (26.7% vs. 21.3%). After 1:1 PSM, a total of 22,089 patients with proportionate baseline characteristics were matched from each cohort. Patients in the fracture cohort had higher proportions of inpatient stays (31.0% vs. 8.1%, p<0.0001), emergency room (ER; 47.0% vs. 15.4%, p<0.0001), physician office (73.6% vs. 47.3%, p<0.0001) and outpatient visits (98.9% vs. 71.6%, p<0.0001). Higher health care resource utilizations translated to higher costs for post-menopausal fracture patients than for controls, including long-term care ($9,191 vs. $7,212, p<0.0001), physician office visit ($428 vs. $293, p<0.0001) and total costs ($17,698 vs. $13,032, p<0.0001). CONCLUSIONS: Post-menopausal women with fractures had significant health care resource utilization and expenses compared to those without fractures.