This study attempts to determine the relation between inhaled corticosteroid use and hip fractures in elderly women, and to compare the rates of hip fracture in women who used inhaled or systemic corticosteriods. This was a retrospective cohort study from January 1, 1993 to March 31, 2000 that linked health care administrative databases for 800,000 women in Ontario, Canada aged 66 years or older. The primary outcome was hospitalization for hip fracture. The incidence of hip fractures was lowest in women who used estrogen and highest in those who use systemic corticosteroids.  Both rates differed significantly from that in the control group of women who used proton pump inhibitors. Systemic but not inhaled corticosteroids were associated with an increased risk of hip fractures in elderly women. Women who used estrogen had a lower risk of hip fracture.