OBJECTIVES: To study the association between the type of antipsychotic drug use and the occurrence of hip fracture in an elderly Medicare population. METHODS: Two years (2006-2007) of 5% national sample of Medicare claims data were used to conduct this population-based retrospective cohort study. Medicare beneficiaries with continuous Part A, B, and D enrollment in 2006-2007 and who initiated atypical or typical antipsychotic therapy July 2006 -June 2007 were identified from Part D claims data. All study subjects were followed for 180 days from index date, the date of first antipsychotic prescription. Propensity scores were calculated for each individual using pre-index demographics, comorbidities, and medication use. Users of atypical antipsychotics and typical antipsychotics were matched on propensity score using the Greedy 5-1 matching algorithm. Conditional logistic regression model stratified on propensity score-matched pair was used to compare the risk of hospitalization for hip fracture in new users of atypical versus typical antipsychotic drugs; sensitivity analysis was conducted using propensity score as a continuous, linear term in the unmatched study cohort using logistic regression. RESULTS: 15,637 new users of atypical and 2,337 new users of typical antipsychotic drugs were identified. 307 (1.7%) of all antipsychotic users had a hospitalization for hip fracture during follow-up. Of these, 40 were typical and 267 were atypical users. In the propensity score-matched cohort of 4,660 individuals (2,330 pairs), 40 (1.72%) typical antipsychotic users and 38 (1.63%) atypical antipsychotic users had a hospitalization for hip fracture during follow-up. The risk of hip fracture was not found to be statistically significant (odds ratio: 1.056; 95% CI: 0.669-1.665) between atypical and typical antipsychotic users. Similar results were obtained in sensitivity analysis (odds ratio: 1.089; 95% CI: 0.775-1.530). CONCLUSIONS: Typical and atypical antipsychotic drug use in an elderly Medicare population has similar risks of hip fracture.