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Abstract (summary): Osteoporosis is a major public health problem resulting in substantial hip fracture related morbidity. Using healthcare utilization data, we determined the 1- and 2-year direct attributable healthcare costs associated with hip fractures among Ontario seniors in comparison to a matched non-hip fracture cohort. Over a four-year period (2004-2008) we identified 22,418 females and 7,611 males with an incident hip fracture. Approximately 22% of females and 30% of males died in the first year after fracture. The mean attributable cost in the first year was $36,929 ($52,232 vs. $15,503) among females and $39,479 ($54,289 vs. $14,810) among males. Primary cost drivers included acute hospitalizations, complex continuing care, and rehabilitation. Attributable costs remained elevated into the second year, particularly among those who survived the first year ($9,017 females and $10,347 males). Results from this study will aid policy decision makers in allocating healthcare resources and help feed into future health economic analyses.