AimsThe aim of the study was to find the epidemiology of hip fractures in heart failure. The increasing survival rate for patients with heart failure places them at risk for other diseases of ageing, including osteoporosis.Methods and resultsWe included 5613 persons from the Cardiovascular Health Study (CHS) with an average of 11.5 year follow-up. We determined incidence rates and hazard ratios (HRs) in persons with heart failure compared with persons without heart failure and mortality hazards following these fractures. Annualized incidence rates for hip fractures were 14 per 1000 person-years in heart failure and 6.8 per 1000 person-years without heart failure. Unadjusted and multivariable adjusted HRs for hip fracture associated with heart failure in men were 1.87 (95 CI 1.2-2.93) and 1.59 (95 CI 0.93-2.72), respectively. Respective HRs for women were 1.75 (95 CI 1.27-2.4) and 1.41 (95 CI 0.98-2.03). Mortality hazard was ∼2-fold greater in patients with heart failure and hip fracture compared with those having heart failure alone.ConclusionPersons with heart failure are at high risk for hip fractures. However, much of the association between hip fractures and heart failure is explained by shared risk factors. Hip fractures are a substantial contributor to mortality in men and women with heart failure. © Published on behalf of the European Society of Cardiology 2009.