Purpose Falls are the cause of over 95% of hip fractures in older adults (Parkkari et al., 1999). An improved understanding of the circumstances of falls that lead to hip fracture may guide the development of strategies for hip fracture prevention (Yang et al., 2020). In this study, we video-captured and analysed real-life falls in two long-term care facilities to determine the biomechanical parameters that may contribute to the occurrence of hip fracture. Method Between April 2007 and October 2018, we captured 2377 falls by 646 residents, in which 30 falls resulted in hip fracture. The mean age (SD) of participants was 82.6 (9.1) years and 57% were female. Each video was analysed by a 3-member team using a validated questionnaire (Yang et al., 2013) to determine the height of the fall, activity at time of fall, occurrence of pelvis impact, initial fall direction, landing configuration, and attempts to recover balance by stepping. For the purpose of this study, we developed an additional questionnaire to determine the sequence of impact to body sites during falls, the orientation and location of pelvis at impact. Generalized Estimating Equations (GEEs) were used to determine relative risk ratios (RRs) for hip fracture associated with various fall characteristics. Results and Discussion Rate of hip fracture was 1.3% (30/2377). All 30 hip fractures involved falls from standing height and pelvis impact with the ground. 28 (93%) falls occurred during walking or standing, and 2 (7%) during rising. Regarding the pelvis orientation at impact, 23 (77%) falls were at the posterior-lateral, 4 (13%) at lateral, and 3 (10%) at posterior or anterior aspect of pelvis. After excluding falls from lower than standing height, risk for hip fracture was higher for sideways landing configurations (RR = 5.50; 95% CI 2.36-12.78) than forward or backward, and for falls causing hip impact (3.38; 1.49-7.67) (Figure 1). However, hip fracture risk was just as high in falls initially directed sideways as forward (1.14; 0.49-2.67), due to the tendency for rotation during descent. Falling while using a mobility aid was associated with lower fracture risk (0.30; 0.09-1.00). Hip protectors were worn in 73% of falls, and hip fracture risk was lower in falls where hip protectors were worn (0.45; 0.21-0.99). Age and sex were not associated with hip fracture risk. There was no evidence of spontaneous fractures. Based on observation of real-life falls, our study provided the first evidence on how fall characteristics are associated with the risk of hip fracture. Compared to non-fracture falls, all hip fractures were resulted from falls from standing height. Pelvis impact occurred generally as the first three sequential sites, which may lead to high energy causing hip fracture. The direct contact of the posterior-lateral pelvis to the ground may also increase the severity of impact at the greater trochanter region. Results from our study will contribute to the design of wearable hip protectors and exercise-based strategies to reduce risk for hip fracture in older adults. [ABSTRACT FROM AUTHOR]