OBJECTIVES: Up to one-third of older adults fall each year with medications representing a well-known risk factor for falling. Ultimately, falls that result in injury are the true target of fall prevention and are of interest to healthcare practitioners. Therefore, this meta-analysis focused on evaluating the association of antipsychotic and antidepressant drugs with hip fracture, a common and debilitating fall-related injury.  METHODS: A search of Pubmed/Medline was conducted from 1966-2010 with key words including “antipsychotic agents”, “psychotropic drugs”, “antidepressive agents”, “aged”, and “hip fracture”. Inclusion criteria included mean age ≥ 65 years and statistical adjustment or stratification by age and gender. Excluded were studies where hip fractures were not distinguished from other fracture types or authors failed to answer queries for required information. A random effects model was used to calculate summary odds ratios for the specific classes of psychotropic medications.  RESULTS: Of 166 studies identified, 10 antipsychotic-related studies and 14 antidepressant-related studies met the inclusion criteria. Combined, these studies represent over 70,000 hip fracture cases and approximately 272,000 total subjects from eight different nations and four continents. Summary odds ratios include (95% confidence interval): conventional antipsychotics 1.68 (1.43, 1.99), atypical antipsychotics 1.30 (1.14, 1.49), tricyclic anti-depressants 1.71 (1.43, 2.04), and selective serotonin re-uptake inhibitors 1.94 (1.37, 2.76). Although some studies reported drug-specific risk measures, the availability of drug-specific data was limited. CONCLUSIONS: All classes considered in this analysis are associated with an increased risk of hip fracture in older adults. There is a trend towards reduced risk associated with atypical antipsychotics compared to conventional antipsychotics, although this does not reach statistical significance. To minimize the risk of hip fracture in older adults requiring psychotropic medications, further research examining the association of hip fractures to specific drugs within these classes is essential.