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Background Chronic inflammation provides the substrate for various mechanisms involved in osteoporotic fracture. The Dietary Inflammatory Index (DII) could shed light on the effect of the inflammatory potential of the diet on osteoporotic hip fracture. Objective This study tested the hypothesis that higher DII scores are associated with greater hip fracture risk in an elderly Chinese population. Methods A 1:1 age- (±3 years), sex- and region-matched case-control study of 1050 pairs (female/male: 781/269) of elderly (age range = 52–83 years) Chinese was conducted in Guangdong, China (2009–2015). Cases were newly diagnosed (within 2 weeks) hip fracture patients and controls were recruited from either communities (n = 835 controls) or the hospital (n = 215). DII scores were calculated from self-reports using a validated 79-item food frequency questionnaire. Odds ratios (ORs) and their 95% confidence intervals (CIs) of the risk of hip fracture for DII scores were estimated from conditional logistic regression. Results The multivariable-adjusted ORs (95% CIs) for hip fracture across quartiles of DII scores were 1 (reference), 1.42 (1.01, 1.99), 1.63 (1.16, 2.28), and 2.44 (1.73, 3.45) ( P trend <.001). Comparing extreme quartiles, the adjusted ORs (95% CIs) for hip fractures were 2.08 (1.38, 3.12) for female and 4.30 (1.89, 9.80) for male participants, respectively ( P interaction = .26). When stratified by the source of controls, a dose-response positive relationship was observed between DII scores and hip fracture risk among community-based controls but not those from the hospital ( P interaction = .16). Conclusions A proinflammatory diet appears to be positively associated with hip fracture risk. [ABSTRACT FROM AUTHOR]