Acute hip pain following a low-force trauma such as a ground-level fall is a common clinical problem. In the elderly osteoporotic population, this is frequently the result of fractures of the proximal femur or pelvis. As physical examination is often inconclusive, imaging is critical for diagnosis. Radiographs are the preferred first-line imaging modality, although their sensitivity is limited for nondisplaced fractures and further imaging may be necessary as discussed in this article and summarized in the recommendations. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.