{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,22]],"date-time":"2026-10-22T19:13:09Z","timestamp":1792696389558,"version":"4.5.0"},"reference-count":39,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2026,7,21]],"date-time":"2026-07-21T00:00:00Z","timestamp":1784592000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medical Sciences"],"abstract":"<jats:p>Background: Inpatient falls are among the most common adverse events in acute-care hospitals and may result in functional decline, prolonged hospitalization, and increased healthcare costs. However, the characteristics of fall-related fractures and recurrent falls in university hospitals have not been fully investigated. Methods: We retrospectively reviewed all inpatient fall events reported to the Department of Patient Safety at Niigata University Medical and Dental Hospital between January 2021 and December 2025. Patients younger than 20 years were excluded. Data regarding patient characteristics, mobility status, fracture occurrence, recurrent falls, medication use, and clinical departments were collected from medical records. Univariate and multivariable logistic regression analyses were performed to identify factors associated with fall-related fractures and recurrent falls. Results: A total of 2571 fall events were identified, yielding an incidence of 2.306 falls per 1000 inpatient-days. Malignant neoplasms were the most common primary diagnosis (36.9%). The incidence of falls was highest in the Departments of Neurology and Neurosurgery. Fall-related fractures occurred in 54 cases (2.1%), most commonly involving the lower extremities, including 17 proximal femoral fractures. Multivariable analysis identified mobility status as the only independent factor associated with fractures (odds ratio [OR], 1.821; 95% confidence interval [CI], 1.263\u20132.627; p = 0.001). Receiver operating characteristic analysis demonstrated a mobility cutoff value of 2.5, indicating an increased fracture risk among patients who were ambulatory with assistive devices or had higher mobility levels. Recurrent falls were observed in 439 patients (24.2%). Reduced mobility (OR, 0.837; 95% CI, 0.713\u20130.981; p = 0.028), polypharmacy (\u22655 medications) (OR, 1.634; 95% CI, 1.254\u20132.016; p &lt; 0.001), and use of central nervous system depressants (OR, 1.363; 95% CI, 1.124\u20131.653; p = 0.002) were independently associated with recurrent falls. Conclusions: Patients with fall-related fractures tended to have relatively high mobility, whereas recurrent falls were associated with reduced mobility, polypharmacy, and central nervous system depressant use. Different characteristics of falls were observed across clinical departments. These findings may help identify patients at high risk for adverse fall-related outcomes and support the development of targeted fall-prevention strategies in university hospitals.<\/jats:p>","DOI":"10.3390\/medsci14030410","type":"journal-article","created":{"date-parts":[[2026,7,21]],"date-time":"2026-07-21T08:14:27Z","timestamp":1784621667000},"page":"410","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Characteristics of Inpatient Falls and Factors Associated with Fall-Related Fractures and Recurrent Falls in a Japanese University Hospital"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2289-7499","authenticated-orcid":false,"given":"Norio","family":"Imai","sequence":"first","affiliation":[{"name":"Division of Comprehensive Musculoskeletal Medicine, Graduate School of Medicine, Dentistry and Health Sciences, Niigata University, Niigata 951-8510, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yoji","family":"Horigome","sequence":"additional","affiliation":[{"name":"Division of Comprehensive Musculoskeletal Medicine, Graduate School of Medicine, Dentistry and Health Sciences, Niigata University, Niigata 951-8510, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daisuke","family":"Homma","sequence":"additional","affiliation":[{"name":"Division of Orthopedic Surgery, Department of Regenerative and Transplant Medicine, Graduate School of Medical and Dental Sciences, Niigata University, Niigata 951-8510, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hiroyuki","family":"Kawashima","sequence":"additional","affiliation":[{"name":"Division of Orthopedic Surgery, Department of Regenerative and Transplant Medicine, Graduate School of Medical and Dental Sciences, Niigata University, Niigata 951-8510, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,7,21]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"82","DOI":"10.1136\/bmj.39049.706493.55","article-title":"Strategies to prevent falls and fractures in hospitals and care homes and effect of cognitive impairment: Systematic review and meta-analyses","volume":"334","author":"Oliver","year":"2007","journal-title":"BMJ"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"e017864","DOI":"10.1136\/bmjopen-2017-017864","article-title":"Effects of falls prevention interventions on falls outcomes for hospitalised adults: Protocol for a systematic review with meta-analysis","volume":"7","author":"Slade","year":"2017","journal-title":"BMJ Open"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"396","DOI":"10.1111\/jep.12144","article-title":"Falls in hospital increase length of stay regardless of degree of harm","volume":"20","author":"Dunne","year":"2014","journal-title":"J. Eval. Clin. Pract."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"367","DOI":"10.5694\/mja15.00296","article-title":"The extra resource burden of in-hospital falls: A cost of falls study","volume":"203","author":"Morello","year":"2015","journal-title":"Med. J. Aust."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"340","DOI":"10.1097\/PTS.0000000000001230","article-title":"Consequences of inpatient falls in acute care: A retrospective register study","volume":"20","author":"Lehtonen","year":"2024","journal-title":"J. Patient Saf."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"201","DOI":"10.1016\/j.injury.2008.06.036","article-title":"Hip fractures after falls in hospital: A retrospective observational cohort study","volume":"40","author":"Johal","year":"2009","journal-title":"Injury"},{"key":"ref_7","first-page":"e46976","article-title":"Inpatient falls and orthopaedic injuries in elderly patients: A retrospective cohort analysis from a falls register","volume":"15","author":"AlSumadi","year":"2023","journal-title":"Cureus"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"732","DOI":"10.1111\/j.1525-1497.2004.30387.x","article-title":"Characteristics and circumstances of falls in a hospital setting","volume":"19","author":"Hitcho","year":"2004","journal-title":"J. Gen. Intern. Med."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"822","DOI":"10.1086\/502500","article-title":"Patterns and predictors of inpatient falls and fall-related injuries in a large academic hospital","volume":"26","author":"Fischer","year":"2005","journal-title":"Infect. Control Hosp. Epidemiol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"425","DOI":"10.1111\/j.1447-0594.2011.00783.x","article-title":"Polypharmacy as a risk for fall occurrence in geriatric outpatients","volume":"12","author":"Kojima","year":"2012","journal-title":"Geriatr. Gerontol. Int."},{"key":"ref_11","unstructured":"Japanese Hospital Association (2024). Quality Indicator (QI) Project Report 2023, Japanese Hospital Association."},{"key":"ref_12","doi-asserted-by":"crossref","unstructured":"Mikos, M., Banas, T., Czerw, A., Banas, B., Strz\u0119pek, \u0141., and Cury\u0142o, M. (2021). Hospital inpatient falls across clinical departments. Int. J. Environ. Res. Public Health, 18.","DOI":"10.3390\/ijerph18158167"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1496","DOI":"10.1378\/chest.11-1708","article-title":"Impairments in systems underlying control of balance in COPD","volume":"141","author":"Beauchamp","year":"2012","journal-title":"Chest"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"213","DOI":"10.1136\/thoraxjnl-2014-206440","article-title":"Sarcopenia in COPD: Prevalence, clinical correlates and response to pulmonary rehabilitation","volume":"70","author":"Jones","year":"2015","journal-title":"Thorax"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"233","DOI":"10.1097\/01.NCQ.0000324588.91837.84","article-title":"The extrinsic risk factors for inpatient falls in hospital patient rooms","volume":"23","author":"Tzeng","year":"2008","journal-title":"J. Nurs. Care Qual."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"41","DOI":"10.1016\/j.jbspin.2010.02.025","article-title":"Glucocorticoid-induced myopathy","volume":"78","author":"Pereira","year":"2011","journal-title":"Jt. Bone Spine"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"S14","DOI":"10.12968\/bjcn.2010.15.Sup1.46906","article-title":"Health-related quality of life and chronic venous leg ulceration","volume":"15","author":"Green","year":"2010","journal-title":"Br. J. Community Nurs."},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"Kridin, K., and Ludwig, R.J. (2018). The growing incidence of bullous pemphigoid: Overview and potential explanations. Front. Med., 5.","DOI":"10.3389\/fmed.2018.00220"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"631","DOI":"10.1038\/jid.2010.357","article-title":"The relationship between neurological disease and bullous pemphigoid: A population-based case-control study","volume":"131","author":"Langan","year":"2011","journal-title":"J. Investig. Dermatol."},{"key":"ref_20","first-page":"21","article-title":"Falls in older adults with cancer: An updated systematic review of prevalence, injurious falls, and impact on cancer treatment","volume":"29","author":"Sattar","year":"2021","journal-title":"Support. Care Cancer"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"470","DOI":"10.1200\/JOP.2014.003517","article-title":"Falls in older adults with cancer: Evaluation by oncology providers","volume":"11","author":"Guerard","year":"2015","journal-title":"J. Oncol. Pract."},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"Kenis, C., Decoster, L., Flamaing, J., Debruyne, P.R., De Groof, I., Focan, C., Corn\u00e9lis, F., Verschaeve, V., Bachmann, C., and Bron, D. (2022). Incidence of falls and fall-related injuries and their predictive factors in frail older persons with cancer: A multicenter study. BMC Geriatr., 22.","DOI":"10.1186\/s12877-022-03574-7"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"1233","DOI":"10.1007\/s10147-022-02194-w","article-title":"Locomotive syndrome in cancer patients: A new role of orthopaedic surgeons as a part of comprehensive cancer care","volume":"27","author":"Kawano","year":"2022","journal-title":"Int. J. Clin. Oncol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"603","DOI":"10.1007\/s10147-023-02312-2","article-title":"Cancer may accelerate locomotive syndrome and deteriorate quality of life: A single-centre cross-sectional study of locomotive syndrome in cancer patients","volume":"28","author":"Hirahata","year":"2023","journal-title":"Int. J. Clin. Oncol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1328","DOI":"10.1016\/j.jos.2021.07.018","article-title":"Assessment of locomotive syndrome in patients with visceral cancer: Comparison with non-cancer patients using propensity score matching","volume":"27","author":"Sato","year":"2022","journal-title":"J. Orthop. Sci."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"199","DOI":"10.1007\/s40266-022-00929-y","article-title":"Opioids and falls risk in older adults: A narrative review","volume":"39","author":"Virnes","year":"2022","journal-title":"Drugs Aging"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"78","DOI":"10.1016\/j.apnr.2014.12.003","article-title":"Factors associated with falls in hospitalized adult patients","volume":"28","author":"Cox","year":"2015","journal-title":"Appl. Nurs. Res."},{"key":"ref_28","first-page":"567","article-title":"Dizziness, imbalance and age-related vestibular loss","volume":"Volume 6","author":"Fritzsch","year":"2020","journal-title":"The Senses: A Comprehensive Reference"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"89","DOI":"10.1016\/j.joto.2019.05.001","article-title":"Vestibular evoked myogenic potentials in patients with diabetes mellitus","volume":"14","author":"Bayram","year":"2019","journal-title":"J. Otol."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"e178","DOI":"10.1097\/MAO.0000000000003792","article-title":"Older adults with vestibular disorders and hip fractures have high rates of meclizine use","volume":"44","author":"Curry","year":"2023","journal-title":"Otol. Neurotol."},{"key":"ref_31","doi-asserted-by":"crossref","unstructured":"Masnoon, N., Shakib, S., Kalisch-Ellett, L., and Caughey, G.E. (2017). What is polypharmacy? A systematic review of definitions. BMC Geriatr., 17.","DOI":"10.1186\/s12877-017-0621-2"},{"key":"ref_32","first-page":"32","article-title":"Polypharmacy: Evaluating risks and deprescribing","volume":"100","author":"Scarbrough","year":"2019","journal-title":"Am. Fam. Physician"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"372.e1","DOI":"10.1016\/j.jamda.2017.12.099","article-title":"Fall-risk-increasing drugs: A systematic review and meta-analysis","volume":"19","author":"Seppala","year":"2018","journal-title":"J. Am. Med. Dir. Assoc."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"329","DOI":"10.1053\/apmr.2002.29623","article-title":"The incidence and consequences of falls in stroke patients during inpatient rehabilitation","volume":"83","author":"Teasell","year":"2002","journal-title":"Arch. Phys. Med. Rehabil."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"817","DOI":"10.1080\/0963828031000122221","article-title":"People with stroke living in the community: Attention deficits, balance, ADL ability and falls","volume":"25","author":"Hyndman","year":"2003","journal-title":"Disabil. Rehabil."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"217","DOI":"10.5152\/alphapsychiatry.2022.21735","article-title":"Falls among psychiatric inpatients: A systematic review of literature","volume":"23","author":"Carpels","year":"2022","journal-title":"Alpha Psychiatry"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"117","DOI":"10.4103\/jmedsci.jmedsci_132_17","article-title":"Influence of medications and psychotic symptoms on fall risk in acute psychiatric inpatients","volume":"38","author":"Lu","year":"2018","journal-title":"J. Med. Sci."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"515","DOI":"10.1182\/blood-2017-09-746420","article-title":"Frailty and the management of hematologic malignancies","volume":"131","author":"Abel","year":"2018","journal-title":"Blood"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"1484","DOI":"10.3324\/haematol.2019.245803","article-title":"Geriatric assessment in older patients with a hematologic malignancy: A systematic review","volume":"105","author":"Scheepers","year":"2020","journal-title":"Haematologica"}],"container-title":["Medical Sciences"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2076-3271\/14\/3\/410\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,21]],"date-time":"2026-07-21T08:45:44Z","timestamp":1784623544000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2076-3271\/14\/3\/410"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,21]]},"references-count":39,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2026,7]]}},"alternative-id":["medsci14030410"],"URL":"https:\/\/doi.org\/10.3390\/medsci14030410","relation":{},"ISSN":["2076-3271"],"issn-type":[{"value":"2076-3271","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,21]]}}}