OBJECTIVES: There are few studies investigating the consequences of fractures in terms of health outcomes. A large prospective Swedish study (KOFOR) assessed quality of life related to fractures of the hip, spine, wrist the first 12 months after fracture. Data were collected using a questionnaire administered by nurses at seven study centres in Sweden. The study indicated that spine fractures are associated with lower quality of life than previously assumed. The purpose of this study is to investigate the long term quality of life data based on the period 13-18 months after fracture. METHODS: A total of 684 patients survived the whole 18 month period and were thus included in the analysis (hip:283, vertebral:76, wrist:325). Patients were asked about their quality of life (EQ-5D) directly after the fracture, at 4 months, 12 months and after 18 months. Recollected QOL before the fracture was also collected. RESULTS: Results show that the QOL-levels reached after 12 months (0.69, 0.49, and 0.88 for hip, spine and wrist respectively) were almost constant after 18 months (0.72, 0.51 and 0.90) indicating that there are persistent QOL-losses associated with osteoporotic fractures. Pre-fracture QOL-values were 0.81, 0.74 and 0.90 for hip, spine and wrist, respectively. A spine fractures are associated with lower long term quality of life levels than previously assumed, and the loss from a spine fracture doubles that of a hip fracture. CONCLUSIONS: Hip and vertebral fractures carries long term effects on QOL and the long term effects of spine fractures are more severe than previously known.