Background <p>Falls are a leading cause of injury, hospitalization, and mortality among older adults. Sedative-hypnotic medications, especially benzodiazepines and Z-drugs, have been implicated as potential contributors to fall risk and fracture. This study investigated the prevalence of sedative-hypnotic drug use in elderly patients with falls and its association with fracture outcomes.</p> Methods <p>A cross-sectional study was conducted on 200 patients aged ≥ 60 years presenting with falls to Rasool Akram Hospital, Tehran (2023–2024). Demographics, comorbidities, and medication history were extracted from medical records. Sedative-hypnotic use was recorded, and outcomes included fracture occurrence confirmed by imaging. Statistical analyses included chi-square tests and multivariate logistic regression.</p> Results <p>Among 200 patients (mean age 73 ± 8 years; 65.5% female), 55.5% sustained a fracture. Sedative-hypnotic use was identified in 15.5% (<i>n</i> = 31). Fracture prevalence was higher in sedative users compared to non-users (74% vs. 52%), but the difference was not statistically significant (<i>p</i> = 0.08). Benzodiazepines were the most commonly used class (15.5%). Losartan use was more frequent in fracture patients (29.7% vs. 12.4%) and showed a significant association in logistic regression (OR 3.28; 95% CI: 1.48–7.26; <i>p</i> = 0.003).</p> Conclusions <p>Sedative-hypnotic use was common among elderly patients presenting with falls; although fracture risk was higher in users, the association did not reach statistical significance, likely due to limited sample size. The observed link between losartan and fractures should be interpreted cautiously and warrants further investigation. Medication review remains a critical component of fall-prevention strategies in geriatric care.</p>