To determine whether simple measurements made on conventional radiographs of the hip could predict hip fractures, we obtained pelvic radiographs on 9704 white women age 65 or older. We analyzed the radiographs of all 162 women who subsequently suffered a hip fracture and 162 randomly selected women who did not. Adjusting for age, four measurements independently predicted hip fracture: reduced thickness of the femoral shaft cortex (odds ratio 1.7 per standard deviation; 95% confidence interval 1.2, 2.3) and of the femoral neck cortex (1.4 per standard deviation; 1.0, 1.9), reduction in an index of tensile trabeculae (2.0 per unit; 1.4, 2.9), and wider trochanteric region (1.4 per standard deviation; 1.0, 2.0). The combination of these four measurements predicted hip fracture at least as strongly as did measurement of bone density of the femoral neck (areas of the receiver-operating characteristic curve = 0.81 and 0.80, respectively). We conclude that simple measurements made on pelvic radiographs predict hip fractures as well as bone density of the hip.