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Proximal femoral fractures are common in elderly osteoporosis patients; however, its prevalence is clinically rare in hip fracture patients with hip osteoarthritis (OA). This study aimed to evaluate bone strength of the proximal femur with or without hip OA and proximal femoral fracture risk using computed tomography (CT)-based finite element analysis (FEA). A retrospective analysis was done on CT data of 20 patients who underwent total hip arthroplasty for unilateral hip OA. Furthermore, the fracture load between OA and contralateral sides was compared and the association between fracture load and risk factor was analyzed. The fracture load was significantly higher in the OA side than that in the contralateral side (3819.5 ± 1557.8 N vs. 3224.5 ± 943.7 N, respectively; P = 0.0405). There was no significant difference in fracture load between OA and the contralateral side in Kellgren–Lawrence (KL)-3 and KL-4 grade, but the KL-4 fracture load tends to be high (P = 0.2461 and P = 0.0527, respectively). Moreover, there was no significant association between fracture load and OA severity or age. The study findings may assist in predicting bone strength and proximal femur fracture risk. The results of this FEA study indicate the bone strength of the proximal femur was affected by the severity of the osteoarthritis. [ABSTRACT FROM AUTHOR]