Sex differences in fall circumstances and injury biomechanics among older adults: A narrative review

Falls are a leading cause of injury and disability among older adults, yet sex-specific differences in fall biomechanics and injury mechanisms remain underexplored. This narrative review synthesizes current evidence on how fall circumstances, intrinsic risk factors, and biomechanical responses differ between older males and females. A comprehensive literature search was conducted using PubMed, ScienceDirect, and Google Scholar, with search terms including "fall biomechanics,""sex differences,""older adults," and "injury risk." We screened peer-reviewed studies and included English-language, human-based research that examined sex-specific fall patterns, injury outcomes, and biomechanical factors. Our findings reveal that while males are more likely to fall from seated positions, females more commonly fall while walking and are prone to sideways and backward falls-patterns associated with increased hip and head injuries. In addition, biological differences such as lower injury thresholds, reduced muscle strength, and distinct soft tissue composition further elevate injury risk in females. Despite these differences, most injury models and prevention guidelines remain male-centric or do not consider sex differences. Our findings underscore the need to integrate sex-specific anatomical and functional characteristics into fall prevention strategies and injury prediction models to improve outcomes for both sexes.