We used Medicare data to conduct a population-based study of osteoporotic hip fracture incidence and outcomes among New England residents. To reduce bias and improve data reliability, we combined data from multiple files; we found that 6% of cases would have been missed had we relied on hospital claims alone. Hip fracture incidence (per 1,000 person-years) increased for white females from 2.2 for ages 65–69 to 31.8 for ages 90–94 and for white males from 0.9 for ages 65–69 to 20.8 for ages 90–94. Incidence among blacks was lower in all age sex groups. The female/male relative risk was greater among whites than among blacks. Case fatality following hip fracture was 12.5% at 90 days and 2 3.7% at 1 year and was higher among males, older patients, and those who had documented comorbidity or who were residents of nursing homes