OBJECTIVE: Psychotropic agents are an established risk factor for hip fractures. These agents induce drowsiness, sleepiness, and orthostatic hypotension. Orthostatic hypotension is a major side effect of anti-hypertensive agents (AH). Conflicting results have been published with respect to AH-agents and the risk of hip fractures, with relative risk estimates ranging from 0.46 (CI 95%: 0.13 – 1.55) to 11.8 (CI 95%: 6.11-22.69). The objective is to assess the risk of hip or wrist fractures in an otherwise healthy hypertensive elderly community population. METHOD: A nested case-control study of AH-users older than 65 years at the first dispensation of an AH (excluding nitrates and high dose furosemide) was conducted on a 10% random sample from Januray 1st 1987 to December 31st 1994, and a 20% sample of all AH-users between August 1st 1992 and August 30th 1997 of the “Régie de l’assurance maladie du Québec” database (RAMQ). Community cases and controls were selected at their first hospitalized index event. Both groups had taken AH-medication and only one antibiotic for a maximum of 14 days in the 92 days preceeding the index day. Cases were subjects with hip or wrist fractures, and controls had pneumonia, cellulitis, diverticulitis, pyelonephritis or acute appendicitis. Conditional logistic regression was performed. RESULTS: From our AH-cohort of 160,940 members, 254 cases and 897 controls were selected. The overall adjusted odds-ratio was 0.87 (CI 95%: 0.66 - 1.17). CONCLUSION: Modern anti-hypertensive therapy does not increase the risk of fractures of the hip or wrist in an otherwise healthy elderly community population.