OBJECTIVES: The primary aim of this study was to assess the incidence of hip fractures in Belgium between 2000-2007 and to examine secular changes within this period. A secondary aim was to estimate the expected number of hip fractures in Belgium until 2050. METHODS: The incidence of hip fractures was determined using the national database of hospital bills, which fully cover the annual hospital stays in the whole of the country. Population data and projections were derived from official sources. Logistic regression including year and age classes was performed for both genders to assess the secular change between 2000-2002 and 2005-2007. Hip fracture projections were made until 2050, assuming the gender-specific secular change observed between 2000-2007 will be maintained. RESULTS: A total of 113,101 hip fractures were recorded in Belgium between 2000 and 2007, of which 76.4% occured in women. The annual number of hip fractures increased from 13,512 in 2000 to 14,744 in 2007, with a more marked increase in men (+20.4%) than in women (+5.7%). Between 2000-2002 and 2005-2007, the age-adjusted incidence of hip fractures significantly decreased by 1.08% per year (95% CI: 0.78 to 1.38) in women, but declined non-significantly by 0.30% per year (95% CI: -0.24 to 0.84) in men. The female/male ratio of hip fractures decreased between these periods from 3.19 to 2.92 (p<0.01). By the year 2050, the number of hip fractures is expected to increase by 37.8% in women and by 110.0% in men. The female/male ratio would decrease to 1.81. CONCLUSIONS: Despite a significant decrease in the age-adjusted incidence of hip fractures in Belgian women and a non-significant decline in men, the number of hip fractures is expected to substantially increase in Belgium. Appropriate public health strategies are therefore needed and should also focus on populations of men.