Abstract INTRODUCTION Inflammatory bowel disease (IBD) patients are off and on treated with steroids which is associated with increased risk of osteoporosis and fragility fractures. We conducted an analysis to study the burden of osteoporotic fractures compared to acute myocardial infarction (AMI) or stroke in hospitalized patients with IBD. METHODS We used the National Inpatient Sample database from 2007 through 2014, to identify patients admitted with primary or secondary diagnosis of IBD using the ICD-9 codes. We identified primary diagnosis of osteoporotic fractures (excluding traumatic injuries, open fracture, readmission indicators), acute myocardial infarction and stroke using respective diagnostic codes. We analyzed trends in nationwide estimates for annual admissions, age at admission, length of stay (LOS), in-patient mortality and total hospital charge (adjusted for inflation). RESULTS Over the eight-year study period, there were an estimated 2,296,145 admissions with IBD. Overall, hip fractures as primary diagnosis accounted for 0.5% of these hospitalizations, non-hip fractures for 0.6%, AMI for 0.8% and stroke for 0.6%. Among patients over 50 years old, the prevalence was 1.0% for hip fractures, 0.9% for non-hip fractures, 1.3% for AMI and 1.0% for stroke. Temporal trend was unchanged over the studied period. More females were admitted with fractures (70.5%) and strokes (55.7%) as compared to AMI (42.4%). Highest mortality was seen among patients admitted for stroke (7.1%), followed by AMI (4.1%) and fractures where mortality with hip fractures was significantly higher than non-hip fractures (2.7% vs 1.7%, p<0.05). The median age for patients with hip fractures was 78, much higher than for non-hip fractures (72), which was close to age for stroke (71), but higher than AMI (67). Mean LOS for stroke was 5.9 days, followed by hip fractures 5.8 days, non-hip fractures 5.6 days, and AMI 5.2 days. Mean charge for hospitalization was similar for hip fractures and non-hip fractures, ($52,399 vs $50,545) which was less than that for stroke ($55,569) and AMI ($70,970). After adjusting for inflation, there was a trend of increase in charge for all four admission diagnoses (Figure 1). CONCLUSION Proportion of IBD patients admitted primarily for nontraumatic fractures is similar to stroke admission, particularly in patients older than 50. Hip fractures are more common than non-hip fractures. Mortality is higher with hip fractures than non-hip fractures. LOS among studied causes is highest for hip fractures and stroke. Cost of hospitalization although not as much with fractures than AMI, showed a rising trend during the study period.