Hip bone pain has a wide range of causes, from overuse injuries and inflamed soft tissue to arthritis, nerve problems, and less common conditions affecting the bone itself. About 14% of adults over 60 report significant hip pain on most days, and women experience it more often than men. Where exactly you feel the pain, how it started, and what makes it worse are the most useful clues for narrowing down the cause.
Where You Feel It Matters
Hip pain isn’t one-size-fits-all. Doctors sort it into three zones: front (groin area), outer side, and back (buttock). Each location points toward a different set of problems, so pinpointing where the pain concentrates is the single most helpful thing you can do before seeking care.
Pain in the front of the hip or deep in the groin is the most common pattern for problems inside the joint itself. Osteoarthritis, labral tears, and hip impingement all show up here. Osteoarthritis produces a constant, deep ache that worsens with prolonged standing or weight bearing. Labral tears cause a dull or sharp groin pain that often radiates to the outer hip or thigh, sometimes with a catching or clicking sensation. Hip impingement typically starts as intermittent groin pain that gradually worsens with athletic activity or long walks.
Pain on the outer side of your hip, right over the bony prominence you can feel when you press, usually points to soft tissue problems rather than the joint. This is called greater trochanteric pain syndrome, a catch-all term for irritation of the tendons, bursae, or muscles that attach near that bump. It hurts most when you lie on the affected side at night and flares up with walking, running, or climbing stairs.
Pain in the buttock area can come from piriformis syndrome, sacroiliac joint dysfunction, or problems in the lower spine. Piriformis syndrome causes buttock pain that worsens with sitting or walking, sometimes sending pain or tingling down the back of the thigh. Sacroiliac joint dysfunction can radiate to the lower back, buttock, and groin all at once.
Is It Bone Pain or Something Else?
When people say their “hip bones hurt,” they sometimes mean the bone itself and sometimes mean the surrounding muscles, tendons, or joint lining. The distinction matters because the causes and treatments differ. True bone pain feels dull and achy, like it’s coming from deep inside your body. You can usually point to a specific spot. It tends to be more intense than muscle soreness and lasts longer.
Muscle and tendon pain, by contrast, feels more spread out along the length of the tissue. It often improves with rest within a few days and is closely tied to specific movements. If your pain is sharp and clearly tied to a single traumatic event, like a fall, that raises the possibility of a fracture, especially in older adults or anyone with thinning bones. Stress fractures from repetitive activity cause groin or front-of-hip pain that gets worse during exercise and eases with rest.
Common Causes in Younger Adults
If you’re in your 20s, 30s, or 40s and dealing with hip bone pain, the most likely culprits are hip impingement and labral tears. Hip impingement happens when the shape of the ball or socket creates abnormal contact during movement. In the “cam” type, a bump on the ball of the femur jams against the socket rim during bending and rotation. In the “pincer” type, the socket itself is too deep or angled in a way that pinches surrounding tissue. Cam impingement is more common in young men.
Over time, impingement can damage the ring of cartilage lining the socket (the labrum), leading to a labral tear. Mechanical symptoms like locking, catching, or clicking during hip movement are common signs. The tricky part is that imaging findings can be subtle and easy to miss on standard X-rays, so if your symptoms match this pattern but initial imaging looks normal, more detailed imaging or a specialist evaluation may be needed.
Osteoarthritis and Wear-Related Pain
Osteoarthritis is the most common cause of persistent hip pain in people over 50. The cartilage cushioning the joint gradually breaks down, leading to bone-on-bone friction. The hallmark is a deep, constant ache with stiffness, especially first thing in the morning or after sitting for a while. Standing and walking make it worse; resting brings partial relief. Over time, range of motion shrinks and everyday tasks like putting on shoes or getting in and out of a car become difficult.
Physical therapy is one of the strongest first-line treatments. About half of the studies on physical therapy for hip osteoarthritis show significant improvements in both pain and function, and no studies suggest it makes things worse. Anti-inflammatory medications consistently reduce pain. Corticosteroid injections into the joint can improve pain and function for at least four months, though they’re not a permanent fix. Hyaluronic acid injections, by contrast, have shown no benefit for hip osteoarthritis despite being marketed for it. Unsupervised exercise programs can be just as effective as formal physical therapy once you’ve learned the right movements, which makes home-based routines a practical long-term strategy.
When Pain Comes From the Spine
Your hip and lower spine share a nerve highway. The femoral, sciatic, and obturator nerves all travel from the lumbar spine through the hip region, which means a problem in your back can produce pain you feel in your hip, groin, thigh, or buttock. This is called referred pain, and it’s one of the most common reasons hip pain gets misdiagnosed.
Spine-related hip pain often has a different character than joint or bone pain. If the sensation is tingling, shock-like, or burning, and especially if it follows a strip-like pattern down your leg or comes with numbness, the source is more likely a pinched nerve in the lower back than the hip joint itself. Some people develop both hip and spine problems simultaneously, a combination doctors call hip-spine syndrome, which makes sorting out the true pain generator even more complicated.
Avascular Necrosis: A Less Common but Serious Cause
Avascular necrosis (also called osteonecrosis) happens when blood supply to the ball of the femur is disrupted, causing bone tissue to die. The pain starts gradually and is usually felt deep in the groin. Left untreated, the bone can eventually collapse.
The major risk factors are worth knowing because some are modifiable. Heavy alcohol use over several years is one of the top causes: it promotes fatty deposits that block the tiny blood vessels feeding the bone. Long-term use of high-dose corticosteroids (often prescribed for autoimmune conditions or after organ transplants) is another leading cause. Previous hip trauma like a dislocation or fracture, radiation therapy, and certain conditions including sickle cell anemia and lupus also raise the risk. If you have ongoing groin pain plus one or more of these risk factors, it’s worth flagging for your doctor specifically.
Pain That Isn’t Coming From the Hip at All
Several conditions outside the hip can mimic hip bone pain. In women, gynecological issues including endometriosis and ovarian cysts can produce pain in the hip and groin region. Urinary tract infections sometimes cause pelvic and hip-area discomfort. Hernias in the groin can feel like anterior hip pain, particularly with coughing or straining.
Red Flags Worth Taking Seriously
Most hip pain is mechanical and manageable, but certain combinations of symptoms suggest something more urgent. Acute hip pain with fever can indicate an infection inside the joint (septic arthritis), which requires rapid treatment to prevent permanent damage. Unexplained weight loss alongside hip pain raises concern for cancer, since breast, prostate, and gynecological cancers can spread to the hip bone. A history of heavy alcohol use or long-term corticosteroid use combined with worsening groin pain should prompt evaluation for avascular necrosis, where earlier detection leads to better outcomes. Any hip pain after a fall in someone over 65 warrants prompt imaging to rule out a fracture, even if the person can still walk.
Physical Activity and Hip Pain Risk
Inactivity itself appears to be a risk factor. Among older adults, 18.4% of those who hadn’t exercised in the past month reported severe hip pain, compared to 12.6% of those who were physically active. That doesn’t mean exercise prevents all hip problems, but it suggests that keeping the muscles around the hip strong and the joint mobile offers some protection. The key is matching the type and intensity of activity to what your hip can currently handle, then building gradually.