OBJECTIVES: In osteoporosis the bone mass is decreased, thereby increasing the risk of fractures. Common osteoporotic fractures include those at the hip, spine and forearm. Fractures are a burden to the society; both in terms of costs, morbidity and mortality. The main objective of this study was to investigate some important aspects of the burden of osteoporosis in Sweden in a health economic perspective. METHODS: The study used a combinated incidence/prevalence bottom-up approach to estimate the total annual burden of osteoporosis in Sweden. The burden was assessed in a societal perspective including medical care costs, non-medical care costs, informal care and indirect costs. Moreover, the value of quality-adjusted life-years (QALYs) foregone because of fractures was included in the total burden estimations. RESULTS: The total annual fracture cost was estimated at MSEK 6547, which is about 3.2% of the total health care costs in Sweden. Community care was the most important cost category accounting for 66% of the total annual cost followed by medical care costs (31%), informal care (2%) and indirect costs (1%). By combining the annual value of QALYs foregone (MSEK 10,354) and the annual fracture costs the total annual societal burden of osteoporosis in Sweden was estimated at MSEK 16 901. Assuming no changes in the age-differentiated fracture risk the burden of osteoporosis was projected to increase to MSEK 26 301 in year 2050. CONCLUSION: This study shows that the societal burden of osteoporosis in Sweden is higher than previously perceived. The burden of osteoporosis is substantial and has to be acknowledged as an important health problem. Osteoporosis related fractures do not only lead to high medical care costs but also lead to high community care costs.