Hip fractures are a major cause of death and disability among the elderly. Although previous studies have shown hip fracture rates to be highest among Whites, and lowest among Blacks, less is known about how these differences are affected by gender and age. We determined the hip fracture hospitalization rates for non-Hispanic Whites, Blacks, Hispanics, and Asians in New York City from 1988 to 2002 using Statewide Planning and Resource Cooperative System data from the New York state Department of Health. We found that hip fracture hospitalization rates for those aged 50 and older were higher for women than men, with a risk ratio of 1.75 (95% confidence interval [CI] 1.73-1.77). Annual age-adjusted hip fracture hospitalization rates among White, Black, Hispanic, and Asian women were 459, 137, 143, and 174 per 100,000, respectively. The corresponding rates for men were 230, 109, 87, and 104, respectively. For both genders, and all race/ethnicity groups, the rates increased sharply with age. Although overall, women had higher rates compared to men, these differences varied by race and age. For Whites and Asians, women had higher rates for all age groups older than 50 years. For Hispanics aged 50-59, men had a higher rate than did women, but this gender relationship reversed after age 60. For Blacks, however, men had higher rates than women until age 70, after which women had higher rates. These results demonstrate that race/ethnicity, as well as age and gender, influence the incidence of hip fractures. Moreover, Asians, with their low bone mass, showed no increased hip fractures, compared to non-Hispanic Blacks and Hispanics. Further study is needed to explain this paradox.