Objective To investigate the prevalence of osteosarcopenia in elderly patients with hip fracture, and to analyze its influencing factors, so as to provide a reference for developing targeted intervention strategies. Methods A total of 252 elderly patients with hip fracture scheduled for surgical treatment were recruited using convenience sampling, then they were assessed using a general information questionnaire, the Physical Activity Scale for the Elderly (PASE), the Nutritional Risk Screening 2002 (NRS-2002), and the Fried Frailty Phenotype within 24 hours after admission. Osteosarcopenia was diagnosed according to the expert consensus criteria for sarcopenia and osteoporosis. Univariate analysis and logistic regression analysis were performed to identify the influencing factors of osteosarcopenia. Results The participants′ prevalence of osteosarcopenia was 35.32%. Logistic regression analysis showed that, glucocorticoid used for ≥6 months, malnutrition, and frailty were risk factors for osteosarcopenia, whereas mode-rate-to-high pre-fracture physical activity level, higher body mass index (BMI), and higher serum total calcium levels were protective factors (all P＜0.05). Conclusion The prevalence of osteosarcopenia is relatively high in elderly patients with hip fracture. Healthcare professionals should pay attention to the assessment of osteosarcopenia and implement targeted interventions according to the influencing factors, so as to prevent or delay its occurrence and progression.