Background <p>The coronavirus disease 2019 (COVID-19) pandemic introduced unprecedented social distancing measures that drastically altered daily activities for older individuals.</p> Aims <p>To investigate whether the proportion of indoor falls changed during the coronavirus disease 2019 (COVID-19) social distancing period in South Korea compared to the pre-COVID-19 period.</p> Methods <p>We conducted a retrospective cohort study at a single tertiary care academic hospital in South Korea of older adult patients who presented to the emergency department and were diagnosed with hip or femur-related fractures during the pre-COVID-19 period (January 2011 to December 2019) or the social distancing period (March 2020 to March 2022). We performed 1:1 propensity score matching. We compared the proportion of indoor and outdoor falls between the two groups.</p> Results <p>A total of 2,433 patients diagnosed with hip or femur-related fractures were included (1,941 before COVID-19 and 492 during the social distancing period). After matching, the proportion of indoor falls was 61.1% in the social distancing group and 67.7% in the pre-COVID-19 group among 316 matched patients in each group (<i>p</i> = 0.02).</p> Conclusions <p>During the COVID-19 social distancing period in South Korea, the proportion of indoor falls decreased significantly compared to the pre-COVID-19 period among older adults with hip or femur-related fractures, suggesting a pandemic-related shift in fall patterns that highlights how lifestyle changes can impact injury patterns and inform fall prevention strategies. However, absence of data on household composition, cognitive status, and medication use, along with tertiary-center selection bias (higher comorbidity burden), limits generalizability.</p> Trial registration number <p>Not applicable.</p>