Osteoporosis affects over 28 million Americans, causing over $13.8 billion in healthcare costs annually. Aging of the population is expected to increase the national burden of osteoporosis, though little is known about state level impacts. In Florida, there is a large and growing at-risk population (6.2 million age 45+ and 2.7 million age 65+). In 1998, there were 25000, 4500, 1600 and 12500 hip, vertebral, forearm/wrist and other fracture hospitalizations, respectively. OBJECTIVE: To predict the costs of osteoporosis in Florida over the next decade. METHODS: Inpatient costs were estimated from Florida hospital discharge data and primary and long-term care costs were obtained from published national estimates. Costs of osteoporosis for women age 50-100 were predicted using a Markov model, which tracked cohort movements across fracture outcome states. We ran 50 consecutive cohorts, starting each year of age 50 through 99, each with a 10 year follow up. Average cost at each individual patient age was adjusted by osteoporosis attribution rates; then the population of women within ages 50-100 was multiplied by average cost to determine total cost by age, within each year (2000-2009). Because fracture incidence rates were unavailable, costs of other fractures and total costs of osteoporosis in males were estimated by multiplying base year costs by the respective population increases over time. RESULTS: Discounted costs of osteoporosis were over $1 billion in 2000 and increased to $1.21 billion (21%) by 2009. The greatest cost increases were for age groups 50-64 and 85+. Total cost for the decade exceeded $11.1 billion. CONCLUSIONS: Osteoporosis is predicted to have substantial and increasing impacts on Florida s healthcare resources. This information may contribute to health policy discussions in Florida.