Abstract: Methods 1:1 matched case-control study was conducted.Cases of incident hip fractures from four hospitals and controls matched by age (3 years) and sex from hospitals or communities were enrolled between January 2008 and July 2013 in Guangdong Province.Study participants were face-to-face interviewed for general demography, daily activities in recent two years, health related behaviors, and parental history of fractures.Univariate and multivariate conditional logistic regressions were used to test the association between physical activity and risks of hip fracture.Age, BMI，education levels, parental history of fractures, smoking and alcohol drinking, vitamins and calcium supplements, and years since menopause (women) were adjusted for multivariate model.Results There were 726 pairs of cases and controls (177 pairs of males and 549 pairs of females).Ages of cases and controls were (71.0±7.0) and (70.9±6 9) years, respectively (P>0.05).Energy consumption in total physical activity and exercise in recent two years of cases (39.5 and 0.91 MET×h/d) were lower than those of controls (53 4 and 1.60 MET×h/d)，P<0.01 for all.Multivariate analyses showed the risks of hip fractures were lower in the highest energy consumption group for total energy consumption of daily average physical activity (OR=0.38) and energy consumption of exercise (OR=0.47), compared with the lowest group; the risk of fracture in group taking part in physical exercise was lower than that in group without physical exercise (OR=0.53).Stratified analyses revealed that high physical activity showed a protective effect only for women; the risks of hip fractures were lower in the highest energy consumption group for total energy consumption of daily average physical activity (OR=0.40) and energy consumption of exercise (OR=0.47) compared with the lowest group; the group who participated regular physical exercise had a lower risk of hip fractures than those who did not (OR=0.51).Conclusion Greater levels of total physical activity and exercise were associated with lower risk of hip fractures in the elderly females in Guangdong Province.