: As the population ages, the number of hip fractures is expected to increase. Developing prevention policies requires knowledge of the factors that lead to the incidence of hip fractures. In this study, we aimed to quantify how much variation in hip fracture incidence can be explained by osteoporosis treatment and temporal trends in the main risk factors. : We used the HIP-IMPACT method for a national study in Romania. This method has been validated nationally in Norway, based on the validated IMPACT models for coronary heart disease. The model uses numerical data from 2008 to 2018 on fractures stratified by sex, the prevalence of pharmacological treatments, and risk and prevention factors. : The HIP-IMPACT model explained 90.1% (4287/4760) of the variation in hip fracture rates recorded during the period of 2008-2018. The increase in the number of fractures was explained by the increase in body mass index (1750/4760; 36.8%), the decrease in the intensity of physical activities (1396/4760; 29.3%), the increase in the prevalence of smoking (1387/4760; 29.1%), the increased prevalence of type 2 diabetes (334/4760; 7.0%), and users of z-drugs (381/4760; 8.0%), glucorticoids (491/4760; 10.3%), and opioids (331/4760; 7.0%). These effects were partially compensated by change over time in the uptake of osteoporosis medication (733/4760; 15.4%), increased prevalence of total hip replacements (491/4760; 10.2%), and reduced benzodiazepine use (559/4760; 11.8%). : From 2008 to 2018, osteoporosis medication contributed to a decrease in hip fractures by one-eighth, while changes in risk factors and prevention contributed to an increase in hip fractures by three-quarters. There is high potential for fracture prevention through pharmacological treatments but also through national policies to increase physical activity, reduce smoking, and lower body mass index (BMI).