In a population-based retrospective cohort study, 624 Rochester, Minnesota residents with an initial symptomatic episode of urolithiasis in 1950 to 1974 were followed for 11,909 person-years for subsequent age-related fractures. During this period of observation, the number of patients with a first vertebral fracture was over four times the number expected on the basis of vertebral fracture incidence rates in the general population of Rochester [standardized morbidity ratio (SMR), 4.3; 95% confidence interval, 3.4 to 5.3]. The risk of vertebral fracture was elevated among men as well as women, and was associated with increasing age and with the use of corticosteroids for more than six months. However, vertebral fracture risk was increased nearly fourfold (SMR 3.9; 95% confidence interval, 3.0 to 4.9) among the urolithiasis patients without such exposure, which suggests that corticosteroids do not completely account for the association with vertebral fractures. There was no increase in the risk of hip, pelvis, proximal humerus or distal forearm fractures in this cohort of patients, and their survival was not impaired. Additional studies are needed to define the pathophysiology of vertebral fractures among patients with urolithiasis.