To examine the association of radiographic features of hand and hip osteoarthritis (OA) in elderly women. Hand and hip radiographs were read for changes of OA from a sample of 1422 women aged 65 and above who were participants in the Study of Osteoporotic Fractures. Definite hip OA required the presence of 2 or more of the following: moderate or large osteophytes, moderate or severe joint space narrowing, subchondral sclerosis, cysts, and femoral head deformity. Definite hand OA required moderate or large osteophytes at 2 or more of the following 6 sites: 2nd and 3rd distal and proximal interphalangeal joints and 1st interphalangeal and carpometacarpal joints. Data were analyzed using multiple logistic regression adjusting for age, weight at age 50, and current height. Overall, 147 (10.4%) women had radiographic changes of definite hip OA and 68 (4.8%) had severe hip OA; 56 had bilateral and 87 had unilateral disease. Definite hand OA was present in 732 (51.4%) women. Hand OA was significantly associated with definite hip OA [odds ratio (OR) = 3.25, 95% confidence intervals (CI) 2.19, 4.84], and severe hip OA (OR = 3.23, 95% CI 1.82, 5.73). Hand OA was significantly associated with bilateral hip OA (OR = 3.54, 95% CI 1.87, 6.73) as well as unilateral hip OA (OR = 3.06, 95% CI 1.84, 5.08). These data are consistent with the inclusion of radiographically defined hip OA in the construct of generalized OA, particularly in elderly women.