OBJECTIVES: To assess the medical management and cost of rachialgia in untreated osteoporotic postmenopausal women and identify the cost induced by vertebral fracture. METHODS: EMERAUDE was a multicenter, prospective, observational study over 6 months. A total of 113 rheumatologists enrolled 427 non-treated osteoporotic patients between 65 and 85 years-old suffering from thoracic and/or lumbar rachialgia. A DEXA Bone Mineral Density measurement and spine x-rays were performed at the beginning of the study. A central reading of x-rays differentiated patients with or without vertebral fracture. Clinical data, medical consumptions and management care were recorded. RESULTS: We report results about the first 195 patients followed during three months. The mean age of patients was 74 years. A total of 50.3% of patients had a vertebral fracture. Patients with vertebral fracture were older (75.5 years versus 72.6 years; p=0.0003) and had a major height loss than women without vertebral fracture. Rachialgia intensity assessed by a visual analogical scale (0-100) was higher for women with vertebral fracture (64.8 versus 59.9; p=0.008). 46% of women with vertebral fracture had had a history of a non-traumatic peripheral fracture against 32% for women without vertebral fracture (p=0.045). For the three months before inclusion; the mean medical cost was 1207€ for patient with vertebral fracture (70% due to hospitalisations) against only 425€ for non-fracture woman. During the three months after inclusion, the mean cost of woman with vertebral fracture was 903€, nearly three times higher than the management cost of a non-fracture woman (p=0.024). CONCLUSION: Our results show that the cost of women suffering from rachialgia depends on the aetiology. Rachialgia secondary to a vertebral fracture induce a higher medical consumption than rachialgia without spinal fracture. These preliminary results, that need to be confirmed, suggest that vertebral fracture, with no routine corrective treatment, is nevertheless a costly condition.