Background <p>Previous investigations have suggested that high-altitude residency may increase the risk of bone loss; however, evidence on the impact of high-altitude exposure on the risk of hip fracture is lacking. Notably, hip fractures are the most serious complication of osteoporosis.</p> Methods <p>We designed and conducted a retrospective cohort analysis using the China Health and Longitudinal Study data from 2011 to 2018. Participants were divided into two groups based on the altitude of their residence, with a threshold of 1500&#xa0;m. Propensity score matching was used to balance covariates, including socioeconomic indicators and medical histories. Univariate Cox regression analysis was performed to evaluate the effect size of high-altitude exposure on the risk of hip fractures. To perform subgroup analysis, the participants were stratified based on sex, body mass index, smoking, and drinking.</p> Results <p>After matching, 399 participants in the high-altitude group and 3192 in the low-altitude group were enrolled. Cox regression showed that exposure to high altitude increased the risk of hip fracture (hazard ratio [HR]: 1.65, 95% confidence interval [CI]: 1.06–2.57, <i>p</i> = 0.03). Subgroup analysis showed that women (HR: 1.996, 95% CI: 1.142–3.491, <i>p</i> = 0.025) and participants with overweight (HR: 2.703, 95% CI: 1.186–6.165, <i>p</i> = 0.034) were vulnerable to the impact of high-altitude exposure compared with men and participants with normal weight.</p> Conclusion <p>Exposure to high altitudes increases the risk of hip fractures, and prevention interventions should receive greater attention in these districts.</p>