ORIGINAL ARTICLE Conflicting trends in fall-related injury hospitalisations among older people: variations by injury type W. L. Watson & R. Mitchell Received: 17 August 2010 / Accepted: 24 November 2010 / Published online: 16 December 2010 # International Osteoporosis Foundation and National Osteoporosis Foundation 2010 Abstract Summary Despite advances in prevention, fall-related hos- pitalisation rates among older people are still increasing. Rates between 1998/1999 and 2008/2009 for non-facture- related injuries increased by 6.1% while fracture injuries declined by -0.4%. Varying trends in rates of different injury types makes it difficult to provide a definitive explanation for these changes. Introduction Despite advances in fall prevention research and practice, the rate of fall-related hospitalisations con- tinues to increase. However, hip fracture rates appear to be declining. An examination of trends in types of injuries that contribute to the overall fall injury rate is required to establish which injuries are driving the falls admission rate. The aim of this paper is to examine trends in fall-related injury hospital admissions by injury type in New South Wales (NSW), Australia. Methods A retrospective review of fall-related injury hospitalisations in NSW among individuals aged 65+years, by injury type, was conducted from 1 July 1998 to 30 June 2009. Direct age-standardised admission rates were calculated. Negative binomial regression was used to examine the statistical significance of changes in trend over time of different hospitalised fall-related injuries. Results The fall-related hospitalisation rate increased by 1.7% each year (p <0.0001; 95% confidence interval (CI), 1.3–2.1%). However, the rate of fracture declined by -0.4% (p <0.03; 95% CI, -0.8–0.0%); whereas, the non-fracture rate increased by 6.1% (p <0.0001; 95% CI, 5.5–6.7%) annually. Rates for severe head injuries, rib and pelvic fracture increased while those for hip and forearm fracture declined. Conclusions It appears that while fall prevention efforts in NSW are not yet affecting the overall rate of injury hospitalisation, there has been a significant decline in the rates of some fractures. Opposing trends in the rates of other fracture admissions and a significant increase in the rate of non-fracture injuries associated with falls makes a definitive explanation for these changes difficult. Keywords Fall injury . Fractures . Injury epidemiology . Non-fracture injury . Older persons Introduction Fall injury in older persons is a significant public health issue worldwide, particularly in high income countries [1]. Around 30% of older people living in the community experience one or more falls each year and fall rates among older people living in residential aged care are significantly higher [1]. Injuries resulting from falls have a major impact on older people and their families with outcomes ranging from fear of falling [2], hospitalisation, loss of indepen- dence [3], admission to residential care [4] and sometimes death. Fall-related injuries among older people also place a considerable burden on the wider community as they result in significant costs to the health care system [5–7]. Despite significant advances in fall injury prevention research and practice, the number of fall-related hospi- talised injuries continues to increase. While this is due W. L. Watson (*) : R. Mitchell NSW Injury Risk Management Research Centre, The University of New South Wales, Kensington, NSW 2052, Australia e-mail: w.watson@unsw.edu.au R. Mitchell School of Aviation, The University of New South Wales, Kensington, NSW 2052, Australia Osteoporos Int (2011) 22:2623–2631 DOI 10.1007/s00198-010-1511-z