OBJECTIVES: To estimate economic burden of patients with osteoporotic hip fracture among Korean women from societal perspective. METHODS: All claims records of Korean National Health Insurance for female aged 50 or older containing a diagnosis of hip fracture from 2002 to 2004 were identified. The first 6-month period was set to be a ‘window period,’ such that patients were defined as incident cases if their first records of fracture visit or admission was observed after June 30, 2002.  We excluded patients with multiple fractures, patients with the records of high-cost diseases such as cancer for the 3-year study period, and patients without records of diagnosis or prescription for osteoporosis for three years.  For each patient, we cumulated the claims amount of the first fracture visit or admission and follow-up treatments for two years after the incidence of fracture.  Also, to investigate out-of-pocket costs outside the healthcare institutions, face-to-face interview was conducted with 101 patients from 4 general hospitals who had experienced hip fracture at least 6 months before the time of the interview. The total cost for fracture was the sum of the direct healthcare costs, transportation costs for visits to hospitals, and caregivers' time cost spent hospital or outpatient visits. RESULTS: A total of 22,247 osteoporotic hip fracture patients were identified during 2.5 years.  For the year of fracture, patients had an average of 3.28 visits and 0.97 admissions, whereas 0.35 visits and 0.02 admissions were recorded for the second year. The 2-year cost was US$8,538 and increased exponentially with age, US$7,616 for 50-64 years old, US$9,542 for 65-74, US$10,077 for 75-84, and US$10,118 for 85 or above. CONCLUSIONS:Exploring the economic burden of osteoporotic hip fracture will motivate policy makers and clinicians to adopt effective treatment options for osteoporosis to prevent the incidence of fracture among elderly population.