Differences in the incidence of hip fractures have been reported between urban and rural areas. In this population-based study the characteristics of fracture patterns between the city of Malmö and the nearby rural district of Sjöbo were compared. A total of 782 individuals in Malmö and 486 in Sjöbo were invited to participate. Fracture history for all invited was registered. The odds ratio for fracture was higher in Malmö, particularly for women over 70. More than half of the urban women aged 70 had a history of a fracture. A fourfold increase in fracture prevalence between the ages of 60 and 70 was observed in women in Malmö, whereas the prevalence doubled in Sjöbo. The differences in fracture patterns between these two urban and rural communities may be explained by different lifestyles.