Objective To investigate the status of hypoxia in the elderly patients with hip fracture at admission and analyze the related risk factors for hypoxia. Methods Clinical data of 1 599 elderly patients with hip fracture treated in Jishuitan Hospital from May 2017 to March 2019 were collected and analyzed retrospectively. According to their oxygenation index and presence of pulmonary disease or not, the patients were divided into pulmonary disease+hypoxemia group (group A, n=136), pulmonary disease+non-hypoxemia group (group B, n=362), non-pulmonary disease+hypoxemia group (group C, n=112) and non-pulmonary disease and non-hypoxemia group (group D, n=989). SPSS statistics 24.0 used. Independent sample t test, one-way ANOVA or Chi-square test was adopted for intergroup comparison based on the data type. The risk factors of hypoxemia were analyzed by binary multivariate logistic regression in the elderly patients. Results About 15.5% (248/1 599) of elderly patients with hip fracture had hypoxemia at the time of emergency treatment. The patients in the hypoxemia groups were significantly older and had obviously higher incidences of pulmonary diseases [54.8%(136/248)vs 26.8%(362/1 351)] and myocardial injury [5.6% (14/248) and 1.7% (23/1 351)] when compared with the non-hypoxemia groups (all P<0.05). There was significant difference in the incidence of fracture between the hypoxemia and non-hypoxemia groups (P<0.01). After exclusion of the factors of lung diseases, the patients in group A were older and had higher incidence of femoral neck fracture [66.9% (91/136) vs 47.8% (173/362)] than those in group B (P<0.01). The level of D-dimer and incidence of femoral neck fracture [62.5% (70/112) vs 52.2% (516/989)] were higher in the group C than the group D (P<0.05). Multivariate logistic regression analysis showed that older age, higher D-dimer level, femoral neck fracture and lung disease were the risk factors of hypoxemia in elderly patients with hip fracture (OR=1.04,1.01,2.04,2.97; all P<0.05). Conclusion Advanced age, high D-dimer level, femoral neck fracture and pulmonary disease are risk factors for hypoxemia in elderly patients with hip fracture. The hypoxic elderly patients with hip fracture are prone to myocardial injury, and hypoxia may increase the risk for adverse myocardial events.