An estimated one in three adults aged 65 years or older falls each year, making falls a major health concern. Hip fractures are the most serious consequences of falls in elderly people. Identifying the characteristics of falls leading to hip fracture may provide information about high risk individuals, environment, and activities useful for the development of intervention strategies. Little is known, however, about the incidence and characteristics of falls leading to hip fracture in Middle Eastern countries. Therefore, the authors presented data from the Iranian Multicenter Study on Accidental Injuries, a prospective population-based study conducted in 9 provinces of Iran in 2003. All the hospitals serving about 9.5 million people in the study area were prospectively surveyed for any incident injury resulting from accidental events. A total of 2,186 patients (1,372 male, 814 female) were admitted due to any injurious fall events, where 572 (26.2%) of them suffered a hip fracture. Annual incidence rates of injurious fall events and related hip fractures were 116.3 and 30.4 per 100,000 person-years, respectively. These figures were 237.1 and 93.6 per 100,000 person-years for people over the age of 50 years, respectively. 71% of fall injuries and 76% of hip fractures occurred indoors. Among 450 patients with hip fractures >or=50 years of age, 61.8% arose from a fall from standing height or less. Only 1 in these 450 hip fractures occurred at the time of recreational activity. In multivariate logistic regression analysis, no factor was an independent predictor of hip fractures comparing to other fall-related injuries among younger participants (>or=20 and <50 years). For older patients, falls from standing height or loss (odds ratio (OR) = 2.67), falls during walking (OR = 1.71), and falls on stairs (OR = 1.73) were detected as risk factors of hip fracture. Married persons and those falling from a ladder or other elevations were less likely to fracture their hip in this age group. Our data suggest that modification of the factors external to the homes is less likely to prevent more than a small proportion of fall-related hip fractures in Iran. Further studies on this topic have potential applications for developing preventive strategies.